Shelby Martin, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

Practice address

5750 Christmas Lake Rd
Excelsior, MN 55331-3303

Phone

(952) 412-1411

NPI assigned

Jan 17, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1484611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1493251200000",
    "number": "1629514401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5750 CHRISTMAS LAKE RD",
            "city": "EXCELSIOR",
            "state": "MN",
            "postal_code": "553313303",
            "telephone_number": "952-412-1411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5750 CHRISTMAS LAKE RD",
            "city": "EXCELSIOR",
            "state": "MN",
            "postal_code": "553313303",
            "telephone_number": "952-412-1411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "SHELBY",
        "credential": "ATC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-01-17",
        "last_updated": "2017-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BLUE CROSS",
            "identifier": "FXF656A22785",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• M. Hope PA
• Taylor Madison
• Michelle Marie Magdsick, CRNA
• Emily Marrs, LMFT
• Natalie Marie Martin, SLP
• Nancy J. Martino, M.A.
• Marty Chiropractic-Excelsior Inc
• Phillip Mark Marty, DC
• Andres Bernard Masis, DPT, ATC/R
• Valetta Johnson Massaquoi, MSN, APRN, FNP-BC

• Athletic Trainer in Excelsior, MN
• Providers in Excelsior, MN by specialty
• Athletic Trainer in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2017; 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.