Active NPI
David S Kisicki, PT
- Physical Therapist
- Glendale, AZ
National Provider Identifier
1184670598
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 5621
- Practice address
- 6520 W Happy Valley Rd
Ste B 109
Glendale, AZ 85310-2615 - Phone
- (623) 561-1300
- Fax
- (623) 561-0036
- NPI assigned
- May 26, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 5621 | AZ | Primary |
Addresses
Primary practice location
6520 W Happy Valley Rd
Ste B 109
Glendale, AZ 85310-2615
Mailing address
6520 W Happy Valley Rd
Ste B 109
Glendale, AZ 85310-2615
Phone (623) 561-1300
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5621 | AZ | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Above & Beyond Therapy Services | Past | Accepting new patients | |
| Agape Therapy, LLC | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Specialist
- Queen Creek, AZ
- NPI 1215252655
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148601600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1277251200000",
"number": "1184670598",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6520 W HAPPY VALLEY RD",
"address_2": "STE B 109",
"city": "GLENDALE",
"state": "AZ",
"postal_code": "853102615",
"telephone_number": "623-561-1300",
"fax_number": "623-561-0036"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6520 W HAPPY VALLEY RD",
"address_2": "STE B 109",
"city": "GLENDALE",
"state": "AZ",
"postal_code": "853102615",
"telephone_number": "623-561-1300",
"fax_number": "623-561-0036"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KISICKI",
"first_name": "DAVID",
"middle_name": "S",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-26",
"last_updated": "2010-06-23",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "AZ",
"license": "5621",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glendale, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.