Shannon Adcock, DPT
Individual provider Active NPI Physical Therapist · Noblesville, IN
NPI 1114003019 · NPPES record last updated Apr 21, 2010
Key facts
- NPI
- 1114003019
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 05008779 (IN)
- Practice address
- 18051 River Ave
Suite 200
Noblesville, IN 46062-7091 - Phone
- (317) 773-0002
- Fax
- (317) 776-6095
- NPI assigned
- Oct 31, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240905001646 | WI | Practitioner - Physical Therapist in Private Practice | 5991724171 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 05008779 | IN | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mercy Health System Corporation | Current |
Accepting new patients | |
| Mercy Health System Corporation | Current |
Accepting new patients | |
| Mercy Health System Corporation | Current | Accepting new patients |
Locations
29624 Network Pl
Chicago, IL 60673
Phone (608) 741-7652
557 N Washington St
Janesville, WI 53548
Phone (608) 754-6000
1000 Mineral Point Ave
Janesville, WI 53548
Phone (608) 261-6868
Interoperability endpoints
- sadcock116691@direct.mhemail.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 05008779 | IN | Yes |
Addresses
Primary practice location
18051 River Ave
Suite 200
Noblesville, IN 46062-7091
Mailing address
18051 River Ave
Suite 200
Noblesville, IN 46062-7091
Phone (317) 773-0002
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200801180 | Medicaid | IN |
Other providers in Noblesville, IN
- Joahnnyflor D Acero
- Active Life Chiropractic Clinic
- Christen Hope Adam
- Angela Kathryn Adams
- Shannon K Adams
- Eric Adolph
- Advanced Gynecology & Pelvic Health Specialists, LLC
- Advantage Chiropractic & Wellness LLC
- Michael A Agostino
- Isabela Aguirre
All providers in Noblesville, IN · Physical Therapist in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 21, 2010. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.