Active NPI
Shyam Sukumar Ullal, P.T.
- Physical Therapist
- Calexico, CA
National Provider Identifier
1558317586
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT10423
- Practice address
- 408 E 3Rd St
Calexico, CA 92231-2854 - Phone
- (760) 357-8864
- Fax
- (760) 357-8866
- NPI assigned
- May 25, 2006
- Last updated
- Jan 25, 2010
- Sex
- Male
- Sole proprietor
- Yes
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 | PT10423 | CA | Primary |
Addresses
Primary practice location
408 E 3Rd St
Calexico, CA 92231-2854
Mailing address
2330 Sandalwood Dr
El Centro, CA 92243-3674
Phone (760) 357-8864
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PT014230 | Medicaid | CA | |
| 5716132 | Other | CA | PIN |
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 |
|---|---|---|---|
| PT10423 | CA | MD | Physical Therapist |
| 10423 | CA | MD | Massage Therapist |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Frontier Worker Fitness & Therapy Sevices
- Physical Therapy Clinic/Center
- Calexico, CA
- NPI 1932398450
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148515200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1264377600000",
"number": "1558317586",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2330 SANDALWOOD DR",
"city": "EL CENTRO",
"state": "CA",
"postal_code": "922433674",
"telephone_number": "760-357-8864",
"fax_number": "760-357-8866"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "408 E 3RD ST",
"city": "CALEXICO",
"state": "CA",
"postal_code": "922312854",
"telephone_number": "760-357-8864",
"fax_number": "760-357-8866"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ULLAL",
"first_name": "SHYAM",
"middle_name": "SUKUMAR",
"name_prefix": "Mr.",
"credential": "P.T.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-05-25",
"last_updated": "2010-01-25",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "PT10423",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "PT014230",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PIN",
"identifier": "5716132",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Calexico, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 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.