NPIMap

Organization Active NPI

Shadduck - Physical Therapy Works Inc

Doing business as PT Works

  • Physical Therapist
  • Los Altos, CA
National Provider Identifier
1114678794
Registry record updated Jan 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
SHADDUCK - PHYSICAL THERAPY WORKS INC
Doing business as
PT Works
Practice address
794 Altos Oaks Dr
Los Altos, CA 94024-5401
Phone
(650) 947-9646
Fax
(650) 947-9566
NPI assigned
Jan 14, 2022
Last updated
Jan 14, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2022

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

Authorized official

Name
Mrs. Kristin Shadduck, PTNPI 1255348462
Title
Physical Therapist, Owner
Phone
(650) 947-9646

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X Primary

Addresses

Primary practice location

794 Altos Oaks Dr
Los Altos, CA 94024-5401

Mailing address

794 Altos Oaks Dr
Los Altos, CA 94024-5401
Phone (650) 947-9646

Other names 1

  • PT WORKS Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220215001108 CA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 6507259538 Receives reassigned benefits from 15 practitioners
Practice locations: Los Altos, CA

National Provider Directory

National Provider Directory

Locations

794 Altos Oaks Dr
Los Altos, CA 94024
Phone (650) 947-9646

Practitioners & affiliated clinicians

Practitioners 25

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1642118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642118400000",
    "number": "1114678794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "794 ALTOS OAKS DR",
            "city": "LOS ALTOS",
            "state": "CA",
            "postal_code": "940245401",
            "telephone_number": "650-947-9646",
            "fax_number": "650-947-9566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "794 ALTOS OAKS DR",
            "city": "LOS ALTOS",
            "state": "CA",
            "postal_code": "940245401",
            "telephone_number": "650-947-9646",
            "fax_number": "650-947-9566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHADDUCK - PHYSICAL THERAPY WORKS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-14",
        "last_updated": "2022-01-14",
        "certification_date": "2022-01-14",
        "status": "A",
        "authorized_official_last_name": "SHADDUCK",
        "authorized_official_first_name": "KRISTIN",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST, OWNER",
        "authorized_official_telephone_number": "650-947-9646",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PT WORKS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Los Altos, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.