Active NPI
Katherine Shao
- Physical Therapist
- Brockton, MA
National Provider Identifier
1003149774
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 18764
- Practice address
- 1115 W Chestnut St
Brockton, MA 02301-7501 - Phone
- (508) 580-4691
- NPI assigned
- Sep 14, 2009
- 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 Therapist | 225100000X | 18764 | MA | Primary |
Addresses
Primary practice location
1115 W Chestnut St
Brockton, MA 02301-7501
Mailing address
23 Jeffrey Cir
Bedford, MA 01730-1553
Phone (617) 921-8309
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 |
|---|---|---|---|
| 18764 | MA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1252886400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1413244800000",
"number": "1003149774",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "23 JEFFREY CIR",
"city": "BEDFORD",
"state": "MA",
"postal_code": "017301553",
"telephone_number": "617-921-8309"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1115 W CHESTNUT ST",
"city": "BROCKTON",
"state": "MA",
"postal_code": "023017501",
"telephone_number": "508-580-4691"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAO",
"first_name": "KATHERINE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-09-14",
"last_updated": "2014-10-14",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MA",
"license": "18764",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brockton, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.