Active NPI
Jacqueline Danielle Shiftlett, PTA
- Physical Therapy Assistant
- Orlando, FL
National Provider Identifier
1639401433
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 20546
- Practice address
- 11301 Corporate Blvd Ste 101
Orlando, FL 32817-8355 - Phone
- (800) 774-7785
- Fax
- (888) 345-7994
- NPI assigned
- Feb 3, 2010
- 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 Therapy Assistant | 225200000X | 20546 | FL | Primary |
Addresses
Primary practice location
11301 Corporate Blvd Ste 101
Orlando, FL 32817-8355
Mailing address
1409 Periwinkle CT.
Lakeland, FL 33811
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20546 | FL | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1265155200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1281052800000",
"number": "1639401433",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1409 PERIWINKLE CT.",
"city": "LAKELAND",
"state": "FL",
"postal_code": "33811"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11301 CORPORATE BLVD STE 101",
"city": "ORLANDO",
"state": "FL",
"postal_code": "328178355",
"telephone_number": "800-774-7785",
"fax_number": "888-345-7994"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHIFTLETT",
"first_name": "JACQUELINE",
"middle_name": "DANIELLE",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-02-03",
"last_updated": "2010-08-06",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "FL",
"license": "20546",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Orlando, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 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.