NPIMap

Organization Active NPI

Shape Shifters Wellness Studio, LLC

  • Specialist
  • Ellicott City, MD
National Provider Identifier
1134516586
Registry record updated Apr 23, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
16510 Issued in MD
Legal business name
SHAPE SHIFTERS WELLNESS STUDIO, LLC
Practice address
169 Frederick Rd
Ellicott City, MD 21043-4886
Phone
(443) 386-0818
Fax
(410) 465-5522
NPI assigned
Apr 23, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2015

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

Authorized official

Name
Ellen Driscoll, P.T.
Title
Physical Therapist/Owner
Phone
(443) 386-0818

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 16510 MD Primary

Addresses

Primary practice location

169 Frederick Rd
Ellicott City, MD 21043-4886

Mailing address

3614 Old Manse CT
Ellicott City, MD 21043-4144
Phone (443) 386-0818

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1429747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1429747200000",
    "number": "1134516586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3614 OLD MANSE CT",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210434144",
            "telephone_number": "443-386-0818",
            "fax_number": "410-465-5522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "169 FREDERICK RD",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210434886",
            "telephone_number": "443-386-0818",
            "fax_number": "410-465-5522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHAPE SHIFTERS WELLNESS STUDIO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-23",
        "last_updated": "2015-04-23",
        "status": "A",
        "authorized_official_last_name": "DRISCOLL",
        "authorized_official_first_name": "ELLEN",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST/OWNER",
        "authorized_official_telephone_number": "443-386-0818",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "MD",
            "license": "16510",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ellicott City, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.