Active NPI
Shaun Vickery, PT, MPT
- Physical Therapist
- Madisonville, KY
National Provider Identifier
1174006209
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 004425
- Practice address
- 425 Island Ford Road
Madisonville, KY 42431 - Phone
- (270) 825-0166
- NPI assigned
- Sep 14, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 004425 | KY | Primary |
Addresses
Primary practice location
425 Island Ford Road
Madisonville, KY 42431
Mailing address
106 Genevieve Dr
Madisonville, KY 42431-5806
Phone (270) 836-6559
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 004425 | KY | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1536883200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1536883200000",
"number": "1174006209",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "106 GENEVIEVE DR",
"city": "MADISONVILLE",
"state": "KY",
"postal_code": "424315806",
"telephone_number": "270-836-6559"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "425 ISLAND FORD ROAD",
"city": "MADISONVILLE",
"state": "KY",
"postal_code": "42431",
"telephone_number": "270-825-0166"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VICKERY",
"first_name": "SHAUN",
"credential": "PT, MPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-09-14",
"last_updated": "2018-09-14",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "KY",
"license": "004425",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Madisonville, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.