Joan Elaine Bourdon, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

14925 Issued in NC

Practice address

900 S. Franklin St
Suite 201
Wake Forest, NC 27587-2797

Phone

(919) 556-1700

Fax

(919) 556-1245

NPI assigned

Oct 27, 2014

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

Other names 1

• Joan Elaine Shallcross Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1414368000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1414368000000",
    "number": "1194120626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 S. FRANKLIN ST",
            "address_2": "SUITE 201",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275872797",
            "telephone_number": "919-556-1700",
            "fax_number": "919-556-1245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 S. FRANKLIN ST",
            "address_2": "SUITE 201",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275872797",
            "telephone_number": "919-556-1700",
            "fax_number": "919-556-1245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOURDON",
        "first_name": "JOAN",
        "middle_name": "ELAINE",
        "name_prefix": "Mrs.",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-10-27",
        "last_updated": "2014-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "14925",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JOAN",
            "last_name": "SHALLCROSS",
            "middle_name": "ELAINE",
            "credential": "P.T.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jonathan Edmund Boes, D.D.S.
• Cameron Bohmer
• Catherine Thornton Boles, DDS
• Jonne Allyson Boone, LCSW, BCD
• Matthew Stephen Boulos, D.O.
• Nicole Bertolino Bourne, OTR/L
• Bowman Family Services Inc
• Robley Kivette Bowman II, MA LPA
• Lydia Elaine Boyd Campbell, MD, MPH
• Stephanie Boykin

• Physical Therapist in Wake Forest, NC
• Providers in Wake Forest, 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 Oct 27, 2014; 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.