Active NPI
Shannon Leigh Stout, P.T.A.
- Physical Therapy Assistant
- Fort Worth, TX
National Provider Identifier
1245521400
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 2039105
- Practice address
- 1400 8TH Ave
Fort Worth, TX 76104-4110 - Phone
- (817) 922-7105
- NPI assigned
- Apr 22, 2011
- 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 | 2039105 | TX | Primary |
Addresses
Primary practice location
1400 8TH Ave
Fort Worth, TX 76104-4110
Mailing address
1400 8TH Ave
Fort Worth, TX 76104-4110
Phone (817) 922-7105
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 |
|---|---|---|---|
| 2039105 | TX | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1303430400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1303430400000",
"number": "1245521400",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1400 8TH AVE",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761044110",
"telephone_number": "817-922-7105"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1400 8TH AVE",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761044110",
"telephone_number": "817-922-7105"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STOUT",
"first_name": "SHANNON",
"middle_name": "LEIGH",
"name_prefix": "Mrs.",
"credential": "P.T.A.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-04-22",
"last_updated": "2011-04-22",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "TX",
"license": "2039105",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.