Active NPI
Susan Shanks West, PT
- Pediatric Physical Therapist
- Kingsport, TN
National Provider Identifier
1376676635
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Physical Therapist
- License
- 1163
- Practice address
- 2971 Fort Henry Dr
Kingsport, TN 37664-4005 - Phone
- (423) 230-8456
- Fax
- (423) 230-8496
- NPI assigned
- Mar 14, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Pediatric Physical Therapist | 2251P0200X | 1163 | TN | Primary |
Addresses
Primary practice location
2971 Fort Henry Dr
Kingsport, TN 37664-4005
Mailing address
116 Lazy LN
Gray, TN 37615-4272
Phone (423) 477-3090
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1163 | TN | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173830400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1376676635",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "116 LAZY LN",
"city": "GRAY",
"state": "TN",
"postal_code": "376154272",
"telephone_number": "423-477-3090",
"fax_number": "423-477-4761"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2971 FORT HENRY DR",
"city": "KINGSPORT",
"state": "TN",
"postal_code": "376644005",
"telephone_number": "423-230-8456",
"fax_number": "423-230-8496"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WEST",
"first_name": "SUSAN",
"middle_name": "SHANKS",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2251P0200X",
"taxonomy_group": "",
"desc": "Physical Therapist, Pediatrics",
"state": "TN",
"license": "1163",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kingsport, TN
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.