Keagan Scott Shillington, DPT
Individual provider Active NPI Physical Therapist · Rathdrum, ID
NPI 1083249197 · NPPES record last updated Mar 9, 2020
Key facts
- NPI
- 1083249197
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- PT-6584 (ID)
- Practice address
- 14775 N Kimo CT Ste a
Rathdrum, ID 83858-8762 - Phone
- (208) 687-9240
- Fax
- (208) 687-9241
- NPI assigned
- Mar 9, 2020
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- University of Colorado School of Medicine, Denver, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Shellman Inc PA
Practice addresses (Care Compare)
1172 W Hayden Ave
Hayden, ID 83835-8700
Phone (208) 762-3332
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200401003212 | ID | Practitioner - Physical Therapist in Private Practice | 9739518382 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT-6584 | ID | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Shellman Inc PA | Physical Therapist | Current |
Accepting new patients |
| North Idaho Day Surgery LLC | Current |
Accepting new patients | |
| Rathdrum Physical Therapy, Inc. | Physical Therapist | Current |
Accepting new patients |
Locations
1917 N Lakewood Dr
Coeur D Alene, ID 83814
Phone (208) 664-8194
1172 W Hayden Ave
Hayden, ID 83835
Phone (208) 762-3332
1593 E Polston Ave
Post Falls, ID 83854
Phone (208) 262-2300
750 N Syringa St
Ste 100
Post Falls, ID 83854
Phone (208) 262-2600
14775 N Kimo Ct
Ste A
Rathdrum, ID 83858
Phone (208) 687-9240
800 W 5th Ave
Spokane, WA 99204
Phone (509) 458-5800
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT-6584 | ID | Yes |
Addresses
Primary practice location
14775 N Kimo CT Ste a
Rathdrum, ID 83858-8762
Mailing address
14775 N Kimo CT Ste a
Rathdrum, ID 83858-8762
Phone (208) 687-9240
Other providers in Rathdrum, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 9, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.