Shane Kenne, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA.0013001 Issued in CO

Practice address

31 Lakeview LN
Woodland Park, CO 80863-8731

Phone

(402) 658-4961

NPI assigned

Apr 5, 2016

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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": "1459814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1459814400000",
    "number": "1053774190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31 LAKEVIEW LN",
            "city": "WOODLAND PARK",
            "state": "CO",
            "postal_code": "808638731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31 LAKEVIEW LN",
            "city": "WOODLAND PARK",
            "state": "CO",
            "postal_code": "808638731",
            "telephone_number": "402-658-4961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNE",
        "first_name": "SHANE",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-04-05",
        "last_updated": "2016-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "CO",
            "license": "PTA.0013001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• JS Hearing Inc.
• Christopher D Kaczmar
• Lyla Keeler, LMT/MMP
• Rachel J Keesling, DO
• Kellyrose Thomas PLLC
• Kingdom Pediatric Therapy
• Michael E Kinne, NP
• Kassandra F Kleymann, CCC-SLP
• Kelly McCall Knott, PT
• Laura Louise Kobilan, NP

• Physical Therapy Assistant in Woodland Park, CO
• Providers in Woodland Park, CO by specialty
• Physical Therapy Assistant in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2016; 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.