Active NPI
Shannon Marie Brostad, PT
- Physical Therapist
- Des Moines, IA
National Provider Identifier
1477608917
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 03523
- Practice address
- 1801 Hickman Rd
Des Moines, IA 50314-1548 - Phone
- (515) 282-5621
- NPI assigned
- Jan 24, 2007
- 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 | 03523 | IA | Primary |
Addresses
Primary practice location
1801 Hickman Rd
Des Moines, IA 50314-1548
Mailing address
4015 Fagen Dr
Des Moines, IA 50310-4047
Phone (515) 276-6676
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IA
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 03523 | IA | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Broadlawns Medical Center | Current | Accepting new patients | |
| Broadlawns Medical Center | Current | Accepting new patients |
Locations
1801 Hickman Rd
Des Moines, IA 50314
Phone (515) 282-2200
2508 E University Ave
Des Moines, IA 50317
Phone (515) 282-2362
580 SW 9th St
Ste 100
Des Moines, IA 50309
Phone (515) 282-2362
2970 University Ave
Des Moines, IA 50311
Phone (515) 216-5100
Organizations & group practices 2
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.
-
- General Acute Care Hospital
- Des Moines, IA
- NPI 1467447508
-
- Pharmacy
- Des Moines, IA
- NPI 1013197060
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169596800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1477608917",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4015 FAGEN DR",
"city": "DES MOINES",
"state": "IA",
"postal_code": "503104047",
"telephone_number": "515-276-6676"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1801 HICKMAN RD",
"city": "DES MOINES",
"state": "IA",
"postal_code": "503141548",
"telephone_number": "515-282-5621"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROSTAD",
"first_name": "SHANNON",
"middle_name": "MARIE",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-24",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IA",
"license": "03523",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Des Moines, IA
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.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.