Krysta Sullivan, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

Practice address

36397 N Gantzel Rd Ste 102
San Tan Valley, AZ 85140-7336

Phone

(480) 567-2987

NPI assigned

Aug 18, 2023

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Inbalance PT LLCGroup PAC ID 4284771767, 7 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Inbalance PT LLC

  • Physical Therapist
  • San Tan Valley, AZ
  • NPI 1760715866
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1692316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692316800000",
    "number": "1780468025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2045 E BOSTON ST APT 4070",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852951857",
            "telephone_number": "714-851-3139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36397 N GANTZEL RD STE 102",
            "city": "SAN TAN VALLEY",
            "state": "AZ",
            "postal_code": "851407336",
            "telephone_number": "480-567-2987"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "KRYSTA",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-08-18",
        "last_updated": "2023-08-18",
        "certification_date": "2023-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tara Lynn Sturdavant, LMT
• Success Residence LLC
• Success Residence LLC
• Shanaya Suchak, D.O
• Richard Suezaki
• Meagan M Sullivan
• Sun West Dental San Tan
• Edgar Arthur Suter, MD
• Ryan Nelson Sutton, FNP
• Donald Todd Swain, DO

• Physical Therapist in San Tan Valley, AZ
• Providers in San Tan Valley, AZ by specialty
• Physical Therapist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.