Shannon Baker Easingwood, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

4530 Issued in SC

Practice address

101 Brightwater Dr
Myrtle Beach, SC 29579-8275

Phone

(843) 903-8300

NPI assigned

Jan 9, 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

Other names 1

• Shannon Denise Easingwood Professional name

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": "1610150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610150400000",
    "number": "1003404583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "223 MAISON DR UNIT 8 BOX 32",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "29572"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 BRIGHTWATER DR",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295798275",
            "telephone_number": "843-903-8300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EASINGWOOD",
        "first_name": "SHANNON",
        "middle_name": "BAKER",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-01-09",
        "last_updated": "2021-01-09",
        "certification_date": "2021-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "SC",
            "license": "4530",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANNON",
            "last_name": "EASINGWOOD",
            "middle_name": "DENISE",
            "credential": "PTA",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Physical Therapy Assistant in Myrtle Beach, SC
• Providers in Myrtle Beach, SC by specialty
• Physical Therapy Assistant in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 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.