Heather Mary Shattuck, PTMS

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

0226661 Issued in NY

Practice address

Gaffney Drive
Watertown, NY 13601

Phone

(315) 788-2730

Fax

(315) 782-6612

NPI assigned

Sep 14, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Ms. Heather Mary Kenyon Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1158192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1467557116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35 COUNTY ROUTE 7",
            "city": "GOUVERNEUR",
            "state": "NY",
            "postal_code": "13642",
            "telephone_number": "315-578-2849",
            "fax_number": "315-782-6612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "GAFFNEY DRIVE",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "13601",
            "telephone_number": "315-788-2730",
            "fax_number": "315-782-6612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHATTUCK",
        "first_name": "HEATHER",
        "middle_name": "MARY",
        "name_prefix": "Mrs.",
        "credential": "PTMS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "0226661",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "HEATHER",
            "last_name": "KENYON",
            "middle_name": "MARY",
            "prefix": "MS.",
            "credential": "PTMS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Bonnie L Servage, ANP
• Raven-Jade Harlequinn Shaddows
• Kylie Shafer, PT, DPT, PCS
• Lacey E Shambo, DNP-BC
• Mark Patrick Sharrow
• Brooke Laforty Shaw, CCC-SLP
• Jana Shaw, MD
• Beverly Shepard, N.P.
• David Peter Shepard, M.A., CCC-SLP
• Deana Shepard

• Physical Therapist in Watertown, NY
• Providers in Watertown, NY by specialty
• Physical Therapist in New York

• 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.

Verify at the official NPI Registry.