Active NPI
Tracy Jean Jolly, B.S
- Physical Therapist
- Fresno, CA
National Provider Identifier
1811166002
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT 10671
- Practice address
- 1357 W Shaw Ave
Suite 101
Fresno, CA 93711-3602 - Phone
- (559) 221-7390
- NPI assigned
- Feb 21, 2008
- Sex
- Female
- 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 | PT 10671 | CA | Primary |
Addresses
Primary practice location
1357 W Shaw Ave
Suite 101
Fresno, CA 93711-3602
Mailing address
1357 W Shaw Ave
Suite 101
Fresno, CA 93711-3602
Phone (559) 221-7390
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
- Credentials
- Bachelor of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT 10671 | CA | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Vibrantcare Outpatient Rehabilitation of California Inc | Past | Accepting new patients |
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 and National Provider Directory roles.
-
dba VibrantCare Outpatient Rehabilitation
- Physical Therapy Clinic/Center
- Fresno, CA
- NPI 1336143981
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1203552000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1203552000000",
"number": "1811166002",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1357 W SHAW AVE",
"address_2": "SUITE 101",
"city": "FRESNO",
"state": "CA",
"postal_code": "937113602",
"telephone_number": "559-221-7390"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1357 W SHAW AVE",
"address_2": "SUITE 101",
"city": "FRESNO",
"state": "CA",
"postal_code": "937113602",
"telephone_number": "559-221-7390"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOLLY",
"first_name": "TRACY",
"middle_name": "JEAN",
"credential": "B.S",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-02-21",
"last_updated": "2008-02-21",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "PT 10671",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fresno, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.