Shane Stovall, RPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

2905 Issued in OK

Practice address

1405 4TH Ave NW # 296
Ardmore, OK 73401-2708

Phone

(580) 795-4768

NPI assigned

Oct 2, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Summit Rehab LLCGroup PAC ID 4486794591, 8 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.

• Summit Rehab LLC

  dba Prohab Therapy Specialists

  • Physical Therapist
  • Madill, OK
  • NPI 1447480082
  Medicare reassignment Care Compare group NPD
• Affiliated Physical Therapists, Inc.

  • Physical Therapist
  • Edmond, OK
  • NPI 1538297759
  NPD (past)

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1253577600000",
    "number": "1205929064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1405 4TH AVE NW # 296",
            "city": "ARDMORE",
            "state": "OK",
            "postal_code": "734012708",
            "telephone_number": "580-795-4768"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1405 4TH AVE NW # 296",
            "city": "ARDMORE",
            "state": "OK",
            "postal_code": "734012708",
            "telephone_number": "580-795-4768"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STOVALL",
        "first_name": "SHANE",
        "credential": "RPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-02",
        "last_updated": "2009-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OK",
            "license": "2905",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1743403 01",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100833900C",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100833900A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Storts Family Dentistry, Jesse D. Storts, Jr. PC
• Jesse D Storts, Jr., D.D.S.
• Lauren Storts, DDS
• Travis Storts, D.D.S.
• Pamela Louise Stout, RN, IBCLC
• Carly Strus, APRN, CNP
• Carol M Stuart, B.S.
• Gregory R Stubbs
• Sudberry Dental
• Thomas Blake Sudberry, D.D.S.

• Physical Therapist in Ardmore, OK
• Providers in Ardmore, OK by specialty
• Physical Therapist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2009; 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.