Active NPI
Shallin Rose Niemyjski, PTA
- Physical Therapy Assistant
- Lake Geneva, WI
National Provider Identifier
1053054692
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- Practice address
- 211 S Curtis St
Lake Geneva, WI 53147-2052 - Phone
- (262) 248-3148
- NPI assigned
- Apr 20, 2022
- 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 Therapy Assistant | 225200000X | Primary |
Addresses
Primary practice location
211 S Curtis St
Lake Geneva, WI 53147-2052
Mailing address
211 S Curtis St
Lake Geneva, WI 53147-2052
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336141357 | Other | FACILITY NPI |
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | sniemyjski@carriagehealthcare.com | ||
| Direct Messaging Address | sniemyjski@carriagehealthcare.com |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1650412800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1650412800000",
"number": "1053054692",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "211 S CURTIS ST",
"city": "LAKE GENEVA",
"state": "WI",
"postal_code": "531472052"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "211 S CURTIS ST",
"city": "LAKE GENEVA",
"state": "WI",
"postal_code": "531472052",
"telephone_number": "262-248-3148"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NIEMYJSKI",
"first_name": "SHALLIN",
"middle_name": "ROSE",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-04-20",
"last_updated": "2022-04-20",
"certification_date": "2022-04-15",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FACILITY NPI",
"identifier": "1336141357",
"state": null
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "sniemyjski@carriagehealthcare.com",
"affiliation": "N",
"address_1": "211 S Curtis St",
"city": "Lake Geneva",
"state": "WI",
"country_code": "US",
"postal_code": "531472052",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "sniemyjski@carriagehealthcare.com",
"affiliation": "N",
"address_1": "211 S Curtis St",
"city": "Lake Geneva",
"state": "WI",
"country_code": "US",
"postal_code": "531472052",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Lake Geneva, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.