Individual provider Active NPI

Shannon Boyd, PT, DPT

  • Physical Therapist
  • Santa Rosa, CA
National Provider Identifier
1275411878
Registry record updated Aug 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT308647 Issued in CA
Practice address
320 Tesconi Cir
Santa Rosa, CA 95401-4611
Phone
(707) 544-2637
NPI assigned
Aug 22, 2025
Last updated
Aug 22, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2025

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 PT308647 CA Primary

Addresses

Primary practice location

320 Tesconi Cir
Santa Rosa, CA 95401-4611

Mailing address

390 Johnson St
Sebastopol, CA 95472-3429
Phone (707) 364-0871

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250911001753 CA Practitioner - Physical Therapist in Private Practice 7618470121 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2025
Medicare assignment
May accept Medicare assignment
Group practices
Select Cal Physical Therapy PCGroup PAC ID 4789070699, 162 clinicians

Practice addresses (Care Compare)

320 Tesconi Cir
Suite G
Santa Rosa, CA 95401-4611
Phone (707) 544-2647

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT308647CAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Select Cal Physical Therapy PC CurrentSince Sep 9, 2025 Accepting new patients
Select Cal Physical Therapy PC Physical Therapist Current Accepting new patients
Select Cal Physical Therapy PC Physical Therapist CurrentSince Sep 9, 2025 Accepting new patients

Locations

1331 Medical Center Dr
Ste A
Rohnert Park, CA 94928
Phone (707) 584-3433

320 Tesconi Cir
Ste G
Santa Rosa, CA 95401
Phone (707) 544-2637

Organizations & group practices 3

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": "1755820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755820800000",
    "number": "1275411878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "390 JOHNSON ST",
            "city": "SEBASTOPOL",
            "state": "CA",
            "postal_code": "954723429",
            "telephone_number": "707-364-0871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 TESCONI CIR",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954014611",
            "telephone_number": "707-544-2637"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOYD",
        "first_name": "SHANNON",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-08-22",
        "last_updated": "2025-08-22",
        "certification_date": "2025-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT308647",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Rosa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2025; 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.