Active NPI
Shannon Kay McDaniel, PT
- Physical Therapist
- Tyler, TX
National Provider Identifier
1235569625
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1106284
- Practice address
- 3400 S Broadway Ave
Suite 205
Tyler, TX 75701-8728 - Phone
- (903) 595-6126
- Fax
- (903) 595-2298
- NPI assigned
- Nov 21, 2013
- Sex
- Female
- 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 | 1106284 | TX | Primary |
Addresses
Primary practice location
3400 S Broadway Ave
Suite 205
Tyler, TX 75701-8728
Mailing address
PO Box 7157
Tyler, TX 75711-7157
Phone (903) 595-6126
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1106284 | Other | TX | PHYSICAL THERAPY LICENSE NUMBER |
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)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1384992000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1384992000000",
"number": "1235569625",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 7157",
"city": "TYLER",
"state": "TX",
"postal_code": "757117157",
"telephone_number": "903-595-6126",
"fax_number": "903-595-2298"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3400 S BROADWAY AVE",
"address_2": "SUITE 205",
"city": "TYLER",
"state": "TX",
"postal_code": "757018728",
"telephone_number": "903-595-6126",
"fax_number": "903-595-2298"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCDANIEL",
"first_name": "SHANNON",
"middle_name": "KAY",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-11-21",
"last_updated": "2013-11-21",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "TX",
"license": "1106284",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHYSICAL THERAPY LICENSE NUMBER",
"identifier": "1106284",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tyler, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.