Shannon Fuller, RPT
Individual provider Active NPI Physical Therapist · Roanoke, AL
NPI 1275947814 · NPPES record last updated Jun 11, 2014
Key facts
- NPI
- 1275947814
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- PTH7164 (AL)
- Practice address
- 1235 Yancey St
Roanoke, AL 36274-2141 - Phone
- (334) 863-3535
- Fax
- (334) 863-7276
- NPI assigned
- Jun 11, 2014
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
Merit-based Incentive Payment System (MIPS)
- Final score
- 81.13 of 100
- Quality
- 82.29
- Improvement activities
- 40
- Cost
- 59.2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140826002553 | AL | Practitioner - Physical Therapist in Private Practice | 3577781947 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PTH7164 | AL | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Therapy Resources,LLC | Physical Therapist | Current |
Accepting new patients |
| TX: Team Rehab Inc. | Physical Therapist | Current |
Accepting new patients |
| Champion Rehab Resources, LLC | Physical Therapist | Past |
Accepting new patients |
Locations
1514 Owens St
Gadsden, AL 35904
Phone (256) 543-1030
305 S 5th St
Gadsden, AL 35901
901 Somerby Dr
Mobile, AL 36695
Phone (251) 222-7974
1235 Yancey St
Roanoke, AL 36274
Phone (256) 543-1030
8910 Purdue Rd
Ste 700
Indianapolis, IN 46268
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PTH7164 | AL | Yes |
Addresses
Primary practice location
1235 Yancey St
Roanoke, AL 36274-2141
Mailing address
1514 Owens St
Gadsden, AL 35904-4938
Phone (256) 543-1030
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7542411 | Other | AL | DRIVER'S LICENSE |
| PTH7164 | Other | AL | AL BOARD OF PHYSICAL THERAPY |
Other providers in Roanoke, AL
- Emerging RX, LLC Dba Emerging Home Care Pharmacy
- Stephanie Lynn Estes
- Evernorth Direct Health LLC
- Evernorth Direct Health LLC
- Faith Homecare, Inc.
- Carleen Michelle Gates
- General Family Dentistry
- God'S Quality Home Health Care
- Greater Alabama Family Foot Care, LLC
- Harmony Angels Home Care, LLC
All providers in Roanoke, AL · Physical Therapist in Alabama
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 11, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.