Active NPI
Shannon Pruitt, PT
- Physical Therapist
- Kansas City, MO
National Provider Identifier
1447608658
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 2005036205
- Practice address
- 851 NW 45TH St
#209
Kansas City, MO 64116-4628 - Phone
- (816) 452-1633
- Fax
- (816) 452-1635
- NPI assigned
- May 27, 2016
- 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 | 2005036205 | MO | Primary |
Addresses
Primary practice location
851 NW 45TH St
#209
Kansas City, MO 64116-4628
Mailing address
851 NW 45TH St
#209
Kansas City, MO 64116-4628
Phone (816) 452-1633
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2005036205 | Other | MO | PT LICENSE # |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2005036205 | MO | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1464307200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1464307200000",
"number": "1447608658",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "851 NW 45TH ST",
"address_2": "#209",
"city": "KANSAS CITY",
"state": "MO",
"postal_code": "641164628",
"telephone_number": "816-452-1633",
"fax_number": "816-452-1635"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "851 NW 45TH ST",
"address_2": "#209",
"city": "KANSAS CITY",
"state": "MO",
"postal_code": "641164628",
"telephone_number": "816-452-1633",
"fax_number": "816-452-1635"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PRUITT",
"first_name": "SHANNON",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-05-27",
"last_updated": "2016-05-27",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MO",
"license": "2005036205",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PT LICENSE #",
"identifier": "2005036205",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kansas City, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.