Shannen Margaret Wallace

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

25919 Issued in MA

Practice address

25 Storey Ave Ste 11
Newburyport, MA 01950-1869

Phone

(978) 499-2370

NPI assigned

Aug 30, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

• Bay State Physical Therapy of Randolph Inc

  • Chiropractor
  • Quincy, MA
  • NPI 1316507627
  NPD
• Integrated Rehabilitation Group, PC

  • Physical Therapy Clinic/Center
  • Mill Creek, WA
  • NPI 1154369833

  Physical Therapist

  NPD
• Integrated Rehabilitation Group, PC

  • Physical Therapy Clinic/Center
  • Marysville, WA
  • NPI 1215201801

  Physical Therapist

  NPD
• Integrated Rehabilitation Group, PC

  • Physical Therapy Clinic/Center
  • Mountlake Terrace, WA
  • NPI 1427831494

  Physical Therapist

  NPD

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

{
    "created_epoch": "1661817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1778025600000",
    "number": "1073233250",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "544E MINISTERIAL RD",
            "city": "WAKEFIELD",
            "state": "RI",
            "postal_code": "028794813",
            "telephone_number": "401-536-7614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 STOREY AVE STE 11",
            "city": "NEWBURYPORT",
            "state": "MA",
            "postal_code": "019501869",
            "telephone_number": "978-499-2370"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3073 White Mountain Hwy",
            "address_purpose": "LOCATION",
            "city": "North Conway",
            "state": "NH",
            "postal_code": "038607101",
            "country_code": "US",
            "telephone_number": "603-373-6000",
            "fax_number": "603-356-9048",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "SHANNEN",
        "middle_name": "MARGARET",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-08-30",
        "last_updated": "2026-05-06",
        "certification_date": "2026-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NH",
            "license": "4900",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MA",
            "license": "25919",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert Videyko, DC
• Sonja Lincoln Vincola, LICSW
• VK Newburyport, LLC
• Walgreen Eastern Co Inc
• Christine Lupa Wallace, N.P.
• Melissa Walsh
• Nicole Walsh
• Steven Guo Wan
• Erin Ward, PT, DPT
• Mark Ryan Warnat, PA-C

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2026; 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.