Shannon Tara Barlow, PT

Primary specialty

Pediatric Rehabilitation Medicine PhysicianTaxonomy code 2081P0010X

License

PT-1900 Issued in ID

Practice address

1001 N 7TH Ave Ste 205
Pocatello, ID 83201-5761

Phone

(208) 239-1490

Fax

(208) 239-1794

NPI assigned

Jun 28, 2022

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Shannon Tara Cook Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Pocatello Hospital LLC

  dba Portneuf Medical Center

  • Psychiatric Hospital Unit
  • Pocatello, ID
  • NPI 1295777274
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1656374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727740800000",
    "number": "1457083487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 N 7TH AVE STE 280",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832015788",
            "telephone_number": "208-239-1490",
            "fax_number": "208-239-1794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 N 7TH AVE STE 205",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832015761",
            "telephone_number": "208-239-1490",
            "fax_number": "208-239-1794"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BARLOW",
        "first_name": "SHANNON",
        "middle_name": "TARA",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-06-28",
        "last_updated": "2024-10-01",
        "certification_date": "2024-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "ID",
            "license": "PT-1900",
            "primary": false
        },
        {
            "code": "2081P0010X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine",
            "state": "ID",
            "license": "PT-1900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANNON",
            "last_name": "COOK",
            "middle_name": "TARA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Sarah Nicolle Baquet, LPC
• Daniel McLean Barclay, DPT
• Jeffery B. Barfuss, BS
• Natalie Barfuss
• Jessica Louise Barlow, TSLP
• Chandra Barney, SLPA
• Whitney Barney, LCSW
• Harriet Barratt, M.D.
• Cynthia Love Barron, CNS
• Tiffany Ann Bascom, LCPC

• Pediatric Rehabilitation Medicine Physician in Pocatello, ID
• Providers in Pocatello, ID by specialty
• Pediatric Rehabilitation Medicine Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.