Active NPI
Shawnna Kennedy
- Physical Therapy Assistant
- Houston, TX
National Provider Identifier
1194206938
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 2096376
- Practice address
- 13220 Breton Ridge St
Houston, TX 77070-5809 - Phone
- (832) 912-4773
- NPI assigned
- Aug 28, 2018
- Sex
- Female
- Sole proprietor
- Yes
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 Therapy Assistant | 225200000X | 2096376 | TX | Primary |
Addresses
Primary practice location
13220 Breton Ridge St
Houston, TX 77070-5809
Mailing address
11915 Cottonwood LN
Cypress, TX 77429-2771
Phone (281) 210-7882
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2096376 | Other | TX | PHYSICAL THERAPIST ASSISTANT- REGULAR LICENSE |
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 |
|---|---|---|---|
| 2096376 | TX | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1535414400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1535414400000",
"number": "1194206938",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11915 COTTONWOOD LN",
"city": "CYPRESS",
"state": "TX",
"postal_code": "774292771",
"telephone_number": "281-210-7882"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13220 BRETON RIDGE ST",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770705809",
"telephone_number": "832-912-4773"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENNEDY",
"first_name": "SHAWNNA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-08-28",
"last_updated": "2018-08-28",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "TX",
"license": "2096376",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHYSICAL THERAPIST ASSISTANT- REGULAR LICENSE",
"identifier": "2096376",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Houston, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 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.