Active NPI
Shaderre Lassiter
- Orthopedic Physical Therapist
- Wilkes Barre, PA
National Provider Identifier
1508737073
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopedic Physical Therapist
- License
- 61133
- Practice address
- 182 Butler St
Wilkes Barre, PA 18702-4465 - Phone
- (888) 510-2095
- NPI assigned
- Sep 16, 2025
- Last updated
- Sep 17, 2025
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Orthopedic Physical Therapist | 2251X0800X | 61133 | PA | Primary |
Addresses
Primary practice location
182 Butler St
Wilkes Barre, PA 18702-4465
Mailing address
423 Scott St Apt 2
Wilkes Barre, PA 18702-5539
Phone (888) 510-2095
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 |
|---|---|---|---|
| 61133 | PA | MD | Orthopedic Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1757980800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1758067200000",
"number": "1508737073",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "423 SCOTT ST APT 2",
"city": "WILKES BARRE",
"state": "PA",
"postal_code": "187025539",
"telephone_number": "888-510-2095"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "182 BUTLER ST",
"city": "WILKES BARRE",
"state": "PA",
"postal_code": "187024465",
"telephone_number": "888-510-2095"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LASSITER",
"first_name": "SHADERRE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-09-16",
"last_updated": "2025-09-17",
"certification_date": "2025-09-17",
"status": "A"
},
"taxonomies": [
{
"code": "2251X0800X",
"taxonomy_group": "",
"desc": "Physical Therapist, Orthopedic",
"state": "PA",
"license": "61133",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wilkes Barre, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.