Active NPI
Shawn Horan, DPT, CSCS
- Physical Therapist
- Villa Rica, GA
National Provider Identifier
1053890707
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT013554
- Practice address
- 2000 Mirror Lake Blvd Ste S
Villa Rica, GA 30180-2126 - Phone
- (770) 456-7877
- Fax
- (770) 456-7880
- NPI assigned
- Aug 13, 2018
- Sex
- Male
- 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 | PT013554 | GA | Primary |
Addresses
Primary practice location
2000 Mirror Lake Blvd Ste S
Villa Rica, GA 30180-2126
Mailing address
2000 Mirror Lake Blvd Ste S
Villa Rica, GA 30180-2126
Phone (770) 456-7877
Other practice location 1
120 Cunningham Dr Ste F
Carrollton, GA 30117-2818
Phone (678) 664-1467
Other practice location 2
2987 Chapel Hill Rd Ste 102
Douglasville, GA 30135-1784
Phone (770) 947-8177
Other practice location 3
500 Nathan Dean Blvd Ste 108
Dallas, GA 30157-4912
Phone (678) 402-7770
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 |
|---|---|---|---|
| PT013554 | GA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1534118400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1534118400000",
"number": "1053890707",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2000 MIRROR LAKE BLVD STE S",
"city": "VILLA RICA",
"state": "GA",
"postal_code": "301802126",
"telephone_number": "770-456-7877",
"fax_number": "770-456-7880"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2000 MIRROR LAKE BLVD STE S",
"city": "VILLA RICA",
"state": "GA",
"postal_code": "301802126",
"telephone_number": "770-456-7877",
"fax_number": "770-456-7880"
}
],
"practiceLocations": [
{
"address_1": "120 Cunningham Dr Ste F",
"address_purpose": "LOCATION",
"city": "Carrollton",
"state": "GA",
"postal_code": "301172818",
"country_code": "US",
"telephone_number": "678-664-1467",
"fax_number": "678-664-1483",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2987 Chapel Hill Rd Ste 102",
"address_purpose": "LOCATION",
"city": "Douglasville",
"state": "GA",
"postal_code": "301351784",
"country_code": "US",
"telephone_number": "770-947-8177",
"fax_number": "770-947-8377",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "500 Nathan Dean Blvd Ste 108",
"address_purpose": "LOCATION",
"city": "Dallas",
"state": "GA",
"postal_code": "301574912",
"country_code": "US",
"telephone_number": "678-402-7770",
"fax_number": "678-402-6947",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "HORAN",
"first_name": "SHAWN",
"credential": "DPT, CSCS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-08-13",
"last_updated": "2018-08-13",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "GA",
"license": "PT013554",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Villa Rica, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.