Shannon Brooke Icenhour, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

P18799 Issued in NC

Practice address

2301 Erwin Rd
Durham, NC 27705-4699

Phone

(919) 660-2220

Fax

(919) 660-2261

NPI assigned

Jul 23, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Duke University Health System, IncGroup PAC ID 2567372345, 1,083 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Duke University Health System, Inc.

  • Certified Registered Nurse Anesthetist
  • Durham, NC
  • NPI 1558392977

  Physical Therapist

  Medicare reassignment Care Compare group NPD
• Duke University Health System, Inc.

  • Parenteral & Enteral Nutrition Supplies (DME)
  • Durham, NC
  • NPI 1427187525
  NPD
• Duke University Health System, Inc.

  • Internal Medicine Physician
  • Durham, NC
  • NPI 1376574798
  NPD (past)

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

{
    "created_epoch": "1563840000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563840000000",
    "number": "1144873670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2400 WORTHING CT",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275874825",
            "telephone_number": "919-961-9675"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 ERWIN RD",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277054699",
            "telephone_number": "919-660-2220",
            "fax_number": "919-660-2261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ICENHOUR",
        "first_name": "SHANNON",
        "middle_name": "BROOKE",
        "name_prefix": "Dr.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-23",
        "last_updated": "2019-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "P18799",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dima Moussa Ibrahim, MD
• Hania Ashraf Ah Ibrahim, MD
• Michael Bassam Ibrahim
• Zina Ibrahim
• Icare Therapy NC LLC
• ICU Christian Counseling Services
• Valerie Benedicta Idada-Parker, DNP, PMHNP-BC, FNP
• Ideal Day Program
• Ideal Home Health Services, Inc
• Idella Wright Homes,LLC

• Physical Therapist in Durham, NC
• Providers in Durham, NC by specialty
• Physical Therapist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.