Lane Marty Shockman, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

09190 Issued in OR

Practice address

600 NW 11TH St
Suite E31
Hermiston, OR 97838-8605

Phone

(541) 667-3657

Fax

(541) 667-3659

NPI assigned

Aug 30, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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.

• Rehab Associates LLC

  • Physical Therapist
  • Hermiston, OR
  • NPI 1275028581
  NPD (past)

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

{
    "created_epoch": "1472515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1472515200000",
    "number": "1487100376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 N.W 11TH",
            "address_2": "SUITE E31",
            "city": "HERMISTON",
            "state": "OR",
            "postal_code": "97838",
            "telephone_number": "541-667-3657",
            "fax_number": "541-667-3659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 NW 11TH ST",
            "address_2": "SUITE E31",
            "city": "HERMISTON",
            "state": "OR",
            "postal_code": "978388605",
            "telephone_number": "541-667-3657",
            "fax_number": "541-667-3659"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHOCKMAN",
        "first_name": "LANE",
        "middle_name": "MARTY",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-08-30",
        "last_updated": "2016-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "OR",
            "license": "09190",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Trisha Rae Scott
• David B Shanley, MD
• Joseph Rozenboom Sharon, DDS
• Jodee Sharp, DOULA
• Meghan Sharp, PT, DPT
• Tamara Shannan Simpson, MD
• Mantinderpreet Singh, MBBS
• Kenneth G. Sjoren, D.D.S.
• Adam T Smith, DO
• Maja Smith

• Physical Therapy Assistant in Hermiston, OR
• Providers in Hermiston, OR by specialty
• Physical Therapy Assistant in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 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.

Verify at the official NPI Registry.