Active NPI
Michelle L Shallow, PTA
- Physical Therapy Assistant
- Marinette, WI
National Provider Identifier
1497190904
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 440
- Practice address
- 4061 Old Peshtigo Rd
Marinette, WI 54143-3887 - Phone
- (715) 732-8000
- NPI assigned
- May 10, 2013
- Last updated
- May 10, 2013
- 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 Therapy Assistant | 225200000X | 440 | WI | Primary |
Addresses
Primary practice location
4061 Old Peshtigo Rd
Marinette, WI 54143-3887
Mailing address
4061 Old Peshtigo Rd
PO Box 0018
Marinette, WI 54143-3887
Phone (715) 732-8000
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 440 | WI | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1368144000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1368144000000",
"number": "1497190904",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4061 OLD PESHTIGO RD",
"address_2": "PO BOX 0018",
"city": "MARINETTE",
"state": "WI",
"postal_code": "541433887",
"telephone_number": "715-732-8000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4061 OLD PESHTIGO RD",
"city": "MARINETTE",
"state": "WI",
"postal_code": "541433887",
"telephone_number": "715-732-8000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHALLOW",
"first_name": "MICHELLE",
"middle_name": "L",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-05-10",
"last_updated": "2013-05-10",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "WI",
"license": "440",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marinette, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.