Active NPI
Shadrack E Spears, PTA
- Physical Therapy Assistant
- Portage, MI
National Provider Identifier
1366635559
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- Practice address
- 1423 W Centre Ave
Portage, MI 49024-5351 - Phone
- (269) 323-4300
- Fax
- (269) 323-4449
- NPI assigned
- Aug 22, 2007
- Sex
- Male
- Sole proprietor
- No
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 | Primary |
Addresses
Primary practice location
1423 W Centre Ave
Portage, MI 49024-5351
Mailing address
4126 Lum St
Portage, MI 49002-6526
Phone (269) 323-4300
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Physical Therapy One, P.C. | Physical Therapy Assistant | Past | Accepting new patients |
| Ivyrehab Michigan, LLC | Past | 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 and National Provider Directory roles.
-
- Sports Medicine (Physical Medicine & Rehabilitation) Physician
- Fenton, MI
- NPI 1104337120
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1187740800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1187740800000",
"number": "1366635559",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4126 LUM ST",
"city": "PORTAGE",
"state": "MI",
"postal_code": "490026526",
"telephone_number": "269-323-4300",
"fax_number": "269-323-4449"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1423 W CENTRE AVE",
"city": "PORTAGE",
"state": "MI",
"postal_code": "490245351",
"telephone_number": "269-323-4300",
"fax_number": "269-323-4449"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SPEARS",
"first_name": "SHADRACK",
"middle_name": "E",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-08-22",
"last_updated": "2007-08-22",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portage, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.