Individual provider Active NPI

Shannon Ward Henne, PT

  • Physical Therapist
  • Jacksonville Beach, FL
National Provider Identifier
1073700811
Registry record updated Jul 7, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
30024 Issued in FL
Practice address
2449 3Rd St S
Jacksonville Beach, FL 32250
Phone
(678) 491-4729
NPI assigned
Sep 25, 2007
Last updated
Jul 7, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 30024 FL Primary

Addresses

Primary practice location

2449 3Rd St S
Jacksonville Beach, FL 32250

Mailing address

2449 3Rd St S
Jacksonville Beach, FL 32250-4066
Phone (904) 372-4016

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

LicenseStateTypeSpecialty
30024FLMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Coremotion Wellness CurrentSince Sep 1, 2019 Accepting new patients
Restore Physical Therapy and Wellness LLC Physical Therapist PastSince Jan 13, 2011 Accepting new patients

Locations

2449 3rd St S
Jacksonville Beach, FL 32250
Phone (678) 491-4729

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1190678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783382400000",
    "number": "1073700811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2449 3RD ST S",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322504066",
            "telephone_number": "904-372-4016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2449 3RD ST S",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "32250",
            "telephone_number": "678-491-4729"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENNE",
        "first_name": "SHANNON",
        "middle_name": "WARD",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-09-25",
        "last_updated": "2026-07-07",
        "certification_date": "2026-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "30024",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 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.