Jack Sullivan, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

LPT-32921 Issued in AZ

Practice address

18561 N 59TH Ave
Glendale, AZ 85308-1256

Phone

(602) 313-4089

Fax

(623) 322-0664

NPI assigned

Nov 19, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ, PA2 enrollments

Enrollment records 2

Specialty

Physical Therapist in Private Practice

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ati Holdings of Arizona LLCGroup PAC ID 2466732862, 223 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Ati Holdings of Arizona, LLC

  • Physical Therapist
  • Phoenix, AZ
  • NPI 1871570309
  Medicare reassignment Care Compare group NPD
• Arizona Luna Care Physical Therapy, LLC

  • Physical Therapist
  • Peoria, AZ
  • NPI 1629698147
  Medicare reassignment NPD
• Pennsylvania Luna Care Physical Therapy LLC

  • Physical Therapist
  • Horsham, PA
  • NPI 1528689445
  Medicare reassignment NPD
• Ideal Rehabilitation LLC

  • Durable Medical Equipment & Medical Supplies
  • Tucson, AZ
  • NPI 1831353614
  NPD (past)

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

{
    "created_epoch": "1605744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738800000000",
    "number": "1790388981",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 BUTTERFIELD RD STE 1600",
            "city": "DOWNERS GROVE",
            "state": "IL",
            "postal_code": "605151211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18561 N 59TH AVE",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853081256",
            "telephone_number": "602-313-4089",
            "fax_number": "623-322-0664"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12023 N Radio Station Rd Ste A",
            "address_purpose": "LOCATION",
            "city": "Seneca",
            "state": "SC",
            "postal_code": "296781143",
            "country_code": "US",
            "telephone_number": "864-985-0770",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "JACK",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-11-19",
        "last_updated": "2025-02-06",
        "certification_date": "2025-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AZ",
            "license": "LPT-32921",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Neven Sudani
• Sudeep Punia MD PC
• Harry Suffron, EDUCATION SPECIALIST
• Chris A Sullivan, PHARMD
• Christopher David Sullivan, M.D, M.P.H.
• Kelli M Sullivan IX
• Ruth Sullivan
• Michael Suman, AT
• Darlene Summers, LPC
• Doug Summers, LISAC

• Physical Therapist in Glendale, AZ
• Providers in Glendale, AZ by specialty
• Physical Therapist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2025; 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.