Jessica Shattuck, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

19301 Issued in MA

Practice address

637 Washington Street
Suite 102
Brookline, MA 02446

Phone

(617) 734-6135

Fax

(617) 734-3744

NPI assigned

Apr 15, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Jessica Paolino Former name

Medicare fee-for-service enrollment

Enrolled in MA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Kinisi LLCGroup PAC ID 2062943533, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Kinisi, LLC

  • Physical Therapy Clinic/Center
  • North Andover, MA
  • NPI 1336883909

  Physical Therapist

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1302825600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1384819200000",
    "number": "1023308681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29 CRAFTS STREET",
            "address_2": "SUITE 570",
            "city": "NEWTON",
            "state": "MA",
            "postal_code": "02458",
            "telephone_number": "617-965-8010",
            "fax_number": "617-965-8071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "637 WASHINGTON STREET",
            "address_2": "SUITE 102",
            "city": "BROOKLINE",
            "state": "MA",
            "postal_code": "02446",
            "telephone_number": "617-734-6135",
            "fax_number": "617-734-3744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHATTUCK",
        "first_name": "JESSICA",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-04-15",
        "last_updated": "2013-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MA",
            "license": "19301",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PT LICENSE",
            "identifier": "19301",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "PAOLINO",
            "credential": "DPT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Diane W Shannon, M.D.
• Ryan Patrick Shannon, LMSW
• Steven I Shapiro, M.D.
• Todd A Shapiro, M.D.
• John R Sharp, M.D.
• Jennifer L Shaw, M.D.
• Lisa Shaw, PH.D.
• Susan Shayegani
• Abigail Shayevich
• Lauren Shebairo

• Physical Therapist in Brookline, MA
• Providers in Brookline, MA by specialty
• Physical Therapist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2013; 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.