Individual provider Active NPI

Shannon S. Arrieta, MPT

  • Physical Therapist
  • Union Grove, WI
National Provider Identifier
1255409934
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
10635-024 Issued in WI
Practice address
1201 Main St
Union Grove, WI 53182-1303
Phone
(262) 878-9602
Fax
(262) 878-9609
NPI assigned
Dec 1, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 10635-024 WI Primary

Addresses

Primary practice location

1201 Main St
Union Grove, WI 53182-1303

Mailing address

3601 30TH Ave Ste 103
Kenosha, WI 53144-1642
Phone (262) 657-0222

Other names 1

  • Shannon S. Fait Former name

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

State licenses

LicenseStateTypeSpecialty
10635WIMDAmbulatory Care Pharmacist
10635-024WIMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Sports Physical Therapy & Rehabilitation Specialists S.C. Physical Therapist Past Accepting new patients
Sports Physical Therapy & Rehab Specialists, S.C. Physical Therapist PastSince Jan 7, 2013 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1164931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1255409934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3601 30TH AVE STE 103",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531441642",
            "telephone_number": "262-657-0222",
            "fax_number": "262-657-7190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 MAIN ST",
            "city": "UNION GROVE",
            "state": "WI",
            "postal_code": "531821303",
            "telephone_number": "262-878-9602",
            "fax_number": "262-878-9609"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ARRIETA",
        "first_name": "SHANNON",
        "middle_name": "S.",
        "name_prefix": "Mrs.",
        "credential": "MPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "10635-024",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANNON",
            "last_name": "FAIT",
            "middle_name": "S.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Union Grove, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.