Active NPI
Courtney Gayle Shull, PT, DPT
- Physical Therapist
- Benton, AR
National Provider Identifier
1639558240
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 3995
- Practice address
- 610 Hwy 5 N
Benton, AR 72019-8559 - Phone
- (501) 794-2269
- NPI assigned
- May 28, 2015
- 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 | 3995 | AR | Primary |
Addresses
Primary practice location
610 Hwy 5 N
Benton, AR 72019-8559
Mailing address
2424 Cedar RDG
Benton, AR 72015-2614
Other names 1
- Courtney Gayle Dixon
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 |
|---|---|---|---|
| 3995 | AR | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1432771200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1432771200000",
"number": "1639558240",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2424 CEDAR RDG",
"city": "BENTON",
"state": "AR",
"postal_code": "720152614"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "610 HWY 5 N",
"city": "BENTON",
"state": "AR",
"postal_code": "720198559",
"telephone_number": "501-794-2269"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHULL",
"first_name": "COURTNEY",
"middle_name": "GAYLE",
"credential": "PT, DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-05-28",
"last_updated": "2015-05-28",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "AR",
"license": "3995",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "COURTNEY",
"last_name": "DIXON",
"middle_name": "GAYLE",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Benton, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.