Active NPI
Shannon Custer
- Physical Therapist
- Dubuque, IA
National Provider Identifier
1013318203
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 12851-24
- Practice address
- 4005 Westmark Dr
Suite 320
Dubuque, IA 52002-2271 - Phone
- (563) 588-3891
- Fax
- (563) 588-3893
- NPI assigned
- Sep 8, 2014
- 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 | 12851-24 | WI | Primary |
Addresses
Primary practice location
4005 Westmark Dr
Suite 320
Dubuque, IA 52002-2271
Mailing address
4005 Westmark Dr
Suite 320
Dubuque, IA 52002-2271
Phone (563) 588-3891
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12851-24 | WI | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dubuque Pediatric Therapies | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Physical Therapist
- Peosta, IA
- NPI 1275472433
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1410134400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1410134400000",
"number": "1013318203",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4005 WESTMARK DR",
"address_2": "SUITE 320",
"city": "DUBUQUE",
"state": "IA",
"postal_code": "520022271",
"telephone_number": "563-588-3891",
"fax_number": "563-588-3893"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4005 WESTMARK DR",
"address_2": "SUITE 320",
"city": "DUBUQUE",
"state": "IA",
"postal_code": "520022271",
"telephone_number": "563-588-3891",
"fax_number": "563-588-3893"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CUSTER",
"first_name": "SHANNON",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-09-08",
"last_updated": "2014-09-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "12851-24",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dubuque, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 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.