Active NPI
Jessica Lee Shudak, PT
- Physical Therapist
- Pittston, PA
National Provider Identifier
1609996842
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 015041
- Practice address
- 38 N Main St
Pittston, PA 18640-1916 - Phone
- (570) 654-0220
- NPI assigned
- Mar 30, 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 | 015041 | PA | Primary |
Addresses
Primary practice location
38 N Main St
Pittston, PA 18640-1916
Mailing address
5800 Bear Creek Boulevard
P.O. Box 348
Bear Creek, PA 18602
Phone (570) 472-3769
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 015041 | PA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175212800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1609996842",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5800 BEAR CREEK BOULEVARD",
"address_2": "P.O. BOX 348",
"city": "BEAR CREEK",
"state": "PA",
"postal_code": "18602",
"telephone_number": "570-472-3769"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "38 N MAIN ST",
"city": "PITTSTON",
"state": "PA",
"postal_code": "186401916",
"telephone_number": "570-654-0220"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHUDAK",
"first_name": "JESSICA",
"middle_name": "LEE",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "PA",
"license": "015041",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pittston, PA
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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.