Active NPI
Shannon Michele Dippold, MPT
- Pediatric Physical Therapist
- Washington, DC
National Provider Identifier
1245567361
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Physical Therapist
- License
- PT872592
- Practice address
- 1301 Pennsylvania Ave SE
Washington, DC 20003-3027 - Phone
- (202) 544-5439
- NPI assigned
- Nov 10, 2009
- 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 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 40QA01243700 | NJ | |
| Physical Therapist | 225100000X | PT872592 | DC | |
| Pediatric Physical Therapist | 2251P0200X | 032014 | NY | |
| Pediatric Physical Therapist | 2251P0200X | PT872592 | DC | Primary |
Addresses
Primary practice location
1301 Pennsylvania Ave SE
Washington, DC 20003-3027
Mailing address
4827 30TH St N
Arlington, VA 22207-2715
Other practice location 1
590 Avenue Of The Americas
Physical Therapy
New York, NY 10011-2019
Phone (646) 459-3600
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 |
|---|---|---|---|
| PT872592 | DC | MD | Physical Therapist |
| 40QA01243700 | NJ | MD | Physical Therapist |
| 032014 | NY | MD | Pediatric Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1257811200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1661299200000",
"number": "1245567361",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4827 30TH ST N",
"city": "ARLINGTON",
"state": "VA",
"postal_code": "222072715"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1301 PENNSYLVANIA AVE SE",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "200033027",
"telephone_number": "202-544-5439"
}
],
"practiceLocations": [
{
"address_1": "590 Avenue Of The Americas",
"address_2": "PHYSICAL THERAPY",
"address_purpose": "LOCATION",
"city": "New York",
"state": "NY",
"postal_code": "100112019",
"country_code": "US",
"telephone_number": "646-459-3600",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "DIPPOLD",
"first_name": "SHANNON",
"middle_name": "MICHELE",
"credential": "MPT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-11-10",
"last_updated": "2022-08-24",
"certification_date": "2022-08-24",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NJ",
"license": "40QA01243700",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "DC",
"license": "PT872592",
"primary": false
},
{
"code": "2251P0200X",
"taxonomy_group": "",
"desc": "Physical Therapist, Pediatrics",
"state": "NY",
"license": "032014",
"primary": false
},
{
"code": "2251P0200X",
"taxonomy_group": "",
"desc": "Physical Therapist, Pediatrics",
"state": "DC",
"license": "PT872592",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Washington, DC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.