Shanna Bisnette

Individual provider Active NPI Physical Therapy Assistant · Westmoreland, KS

NPI 1104056985 · NPPES record last updated Mar 4, 2024

Key facts

NPI
1104056985
Entity type
Individual (NPI type 1)
Primary specialty
Physical Therapy Assistant 225200000X
License
14-01989 (KS)
Practice address
105 N, KS-99
Westmoreland, KS 66549
Phone
(785) 457-2801
Fax
(512) 310-9228
NPI assigned
Jul 15, 2009
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
14-01989KSMDPhysical Therapy Assistant

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X 14-01989 KS Yes

Addresses

Primary practice location

105 N, KS-99
Westmoreland, KS 66549

Mailing address

105 N, KS-99
Westmoreland, KS 66549

Other identifiers

IdentifierTypeStateIssuer
0031DGOtherBLUE CROSS BLUE SHIELD
0944746-02MedicaidTX
74-2745294OtherTAX ID

Other providers in Westmoreland, KS

All providers in Westmoreland, KS · Physical Therapy Assistant in Kansas

Sources for this page

Verify at the official NPI Registry.