Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jack Sullivan, DPT

Individual provider Physical Therapist · NPI 1790388981

Jack Sullivan, DPT is a Physical Therapist in Private Practice in Glendale, Arizona. Qualified in 2020, 6 years ago. Practices with Ati Holdings of Arizona LLC, a 231-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Arizona.

Years since qualifying
6
Licensed in
AZ
In the registry since
2020
Specialties on file
2
What do these letters mean?
DPT — Doctor of Physical Therapy
The doctoral degree now required to enter physical therapy practice.

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Practice location Address checks out

18561 N 59th Ave
Glendale, AZ 85308-1256
Phone: (602) 313-4089
Fax: (623) 322-0664
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 12023 N Radio Station Rd Ste A, Seneca, SC 29678-1143 — (864) 985-0770

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence LPT-32921 (AZ)
Physical Therapist Taxonomy 225100000X

Record details

NPI number1790388981
Entity typeIndividual (Type 1)
GenderMale
Credentials DPT
Sole proprietorNo
NPI enumeratedNovember 19, 2020
Last updated in NPPESFebruary 6, 2025
Certification dateFebruary 6, 2025
Mailing address2001 Butterfield Rd Ste 1600, Downers Grove, IL 60515-1211

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice Ati Holdings Of Arizona Llc — 231 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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