Shane Nissen

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

004889 Issued in IA

Practice address

629 Granada Rd
Carroll, IA 51401-1709

Phone

(712) 210-2147

NPI assigned

Jan 30, 2013

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

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.

• Eugene Physical Therapy at Oak Street

  • Orthopedic Physical Therapist
  • Eugene, OR
  • NPI 1326291519
  NPD (past)

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

{
    "created_epoch": "1359504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1359504000000",
    "number": "1629316369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "629 GRANADA RD",
            "city": "CARROLL",
            "state": "IA",
            "postal_code": "514011709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "629 GRANADA RD",
            "city": "CARROLL",
            "state": "IA",
            "postal_code": "514011709",
            "telephone_number": "712-210-2147"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NISSEN",
        "first_name": "SHANE",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-01-30",
        "last_updated": "2013-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AZ",
            "license": "9706",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IA",
            "license": "004889",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• New Opportunities, Inc.
• New Opportunities, Inc.
• Next Generation Chiropractic, PLLC
• Nicholas J. Fangman DDS
• Randi Nichols, HIS
• Glenna R Nockels, LMSW
• Northland Hearing Centers, Inc.
• David Nystrom, D.O.
• Victor Ogoti
• Omaha Vamc

• All providers in Carroll, IA
• Physical Therapist in Iowa

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

Verify at the official NPI Registry.