Active NPI
Jennifer L McNulty, LPTA
- Physical Therapy Assistant
- Morton, IL
National Provider Identifier
1891996567
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- Practice address
- 100 Cedar Ave
Morton, IL 61550-1008 - Phone
- (309) 267-3536
- NPI assigned
- May 30, 2007
- 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 | IL | Primary |
Addresses
Primary practice location
100 Cedar Ave
Morton, IL 61550-1008
Mailing address
5715 N. Terrace CT.
Peoria Heights, IL 61616
Phone (309) 267-3536
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 |
|---|---|---|---|
| 160-004200 | IL | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1180483200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1891996567",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5715 N. TERRACE CT.",
"city": "PEORIA HEIGHTS",
"state": "IL",
"postal_code": "61616",
"telephone_number": "309-267-3536"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 CEDAR AVE",
"city": "MORTON",
"state": "IL",
"postal_code": "615501008",
"telephone_number": "309-267-3536"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCNULTY",
"first_name": "JENNIFER",
"middle_name": "L",
"credential": "LPTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Morton, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.