Individual provider Active NPI

Christopher Shannon, DPT

  • Physical Therapist
  • Kent, WA
National Provider Identifier
1023188430
Registry record updated Jul 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT00008717 Issued in WA
Practice address
13215 SE 240TH St
Suite D
Kent, WA 98042-5120
Phone
(253) 631-3026
Fax
(253) 631-3899
NPI assigned
Nov 9, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT00008717 WA Primary

Addresses

Primary practice location

13215 SE 240TH St
Suite D
Kent, WA 98042-5120

Mailing address

PO Box 5718
Kalispell, MT 59903-5718
Phone (855) 456-7146

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050226000074 WA Practitioner - Physical Therapist in Private Practice 3173576451 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Puget Sound Health and Rehab LLCGroup PAC ID 8426335118, 3 clinicians

Practice addresses (Care Compare)

13215 SE 240TH St
Suite D
Kent, WA 98042-5120
Phone (253) 631-3026

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT00008717WAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Puget Sound Health and Rehab LLC Physical Therapist CurrentSince Apr 3, 2017 Accepting new patients

Locations

13215 SE 240th St
Ste D
Kent, WA 98042
Phone (253) 631-3026

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.

NPI Registry JSON

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

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594857600000",
    "number": "1023188430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5718",
            "city": "KALISPELL",
            "state": "MT",
            "postal_code": "599035718",
            "telephone_number": "855-456-7146",
            "fax_number": "406-309-2579"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13215 SE 240TH ST",
            "address_2": "SUITE D",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980425120",
            "telephone_number": "253-631-3026",
            "fax_number": "253-631-3899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHANNON",
        "first_name": "CHRISTOPHER",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-09",
        "last_updated": "2020-07-16",
        "certification_date": "2020-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT00008717",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kent, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.