Jazzlyn Marie Petry, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA30959 Issued in FL

Practice address

2600 Compass Rd
Glenview, IL 60026-8001

Phone

(877) 787-3422

NPI assigned

Jun 25, 2021

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1624579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624579200000",
    "number": "1982274783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9000 MANCHESTER LN UNIT 20A",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329042092",
            "telephone_number": "937-467-9198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 COMPASS RD",
            "city": "GLENVIEW",
            "state": "IL",
            "postal_code": "600268001",
            "telephone_number": "877-787-3422"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "500 Crockett Blvd",
            "address_purpose": "LOCATION",
            "city": "Merritt Island",
            "state": "FL",
            "postal_code": "329535034",
            "country_code": "US",
            "telephone_number": "321-454-4035",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETRY",
        "first_name": "JAZZLYN",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-06-25",
        "last_updated": "2021-06-25",
        "certification_date": "2021-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "FL",
            "license": "PTA30959",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "6/25/2036",
            "affiliation": "N",
            "address_1": "2600 Compass Rd",
            "city": "Glenview",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600268001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Vanessa Peters, APN
• Wendy Peters, MS, ATC
• Chelsea Petersen
• Claudia F. Petersen, MD
• Rachel Nichole Peterson, OTR/L
• Laura Benedict Pettineo, PHD
• Brooke Pfanz
• Nicklas Robert Pfanzelter, MD
• Brooke Pfest, RD
• Angelie Pham

• Physical Therapy Assistant in Glenview, IL
• Providers in Glenview, IL by specialty
• Physical Therapy Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.