Active NPI
Shylla Sobusa
- Physical Therapist
- Baltimore, MD
National Provider Identifier
1376072520
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 23059
- Practice address
- 700 W 40TH St
Baltimore, MD 21211-2140 - Phone
- (410) 662-4284
- NPI assigned
- Jun 9, 2017
- Last updated
- Jun 9, 2017
- Sex
- Female
- 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 Therapist | 225100000X | 23059 | MD | Primary |
Addresses
Primary practice location
700 W 40TH St
Baltimore, MD 21211-2140
Mailing address
157 Baltimore St
Cumberland, MD 21502-2472
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
Care Compare profile
Medicare Care Compare- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2002
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
9513 Tessa LN
Owings Mills, MD 21117-3276
PO Box
Suite 290609
Nashville, TN 37229
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23059 | MD | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1496966400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1496966400000",
"number": "1376072520",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "157 BALTIMORE ST",
"city": "CUMBERLAND",
"state": "MD",
"postal_code": "215022472"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "700 W 40TH ST",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212112140",
"telephone_number": "410-662-4284"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SOBUSA",
"first_name": "SHYLLA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-06-09",
"last_updated": "2017-06-09",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MD",
"license": "23059",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Baltimore, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- 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.