Active NPI
Joan E Dulle, RPT
- Physical Therapist
- Jefferson City, MO
National Provider Identifier
1528217965
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 103136
- Practice address
- 1030 Edmonds St
Jefferson City, MO 65109-5213 - Phone
- (615) 896-6400
- NPI assigned
- Sep 10, 2008
- Last updated
- Sep 10, 2008
- Sex
- Female
- 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 | 103136 | MO | Primary |
Addresses
Primary practice location
1030 Edmonds St
Jefferson City, MO 65109-5213
Mailing address
5105 Wardsville Rd
Jefferson City, MO 65101-8743
Phone (615) 896-6400
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 |
|---|---|---|---|
| 103136 | MO | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1221004800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1221004800000",
"number": "1528217965",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5105 WARDSVILLE RD",
"city": "JEFFERSON CITY",
"state": "MO",
"postal_code": "651018743",
"telephone_number": "615-896-6400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1030 EDMONDS ST",
"city": "JEFFERSON CITY",
"state": "MO",
"postal_code": "651095213",
"telephone_number": "615-896-6400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DULLE",
"first_name": "JOAN",
"middle_name": "E",
"credential": "RPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-09-10",
"last_updated": "2008-09-10",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MO",
"license": "103136",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jefferson City, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.