Active NPI
Shannon F Burbank
- Physical Therapy Assistant
- Nampa, ID
National Provider Identifier
1093280307
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 5839
- Practice address
- 1127 Caldwell Blvd
Nampa, ID 83651-1701 - Phone
- (209) 465-4935
- NPI assigned
- Oct 12, 2018
- Sex
- Female
- 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 Therapy Assistant | 225200000X | 5839 | ID | Primary |
Addresses
Primary practice location
1127 Caldwell Blvd
Nampa, ID 83651-1701
Mailing address
2697 W Los Flores CT
Meridian, ID 83646-5468
Phone (120) 888-4382
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5839 | ID | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1539302400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1539302400000",
"number": "1093280307",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2697 W LOS FLORES CT",
"city": "MERIDIAN",
"state": "ID",
"postal_code": "836465468",
"telephone_number": "120-888-4382"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1127 CALDWELL BLVD",
"city": "NAMPA",
"state": "ID",
"postal_code": "836511701",
"telephone_number": "209-465-4935"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BURBANK",
"first_name": "SHANNON",
"middle_name": "F",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-10-12",
"last_updated": "2018-10-12",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "ID",
"license": "5839",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Nampa, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 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.