Shannon B Welch, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

40QA01495000 Issued in NJ

Practice address

58 Portland Rd
Summit, NJ 07901-3045

Phone

(908) 447-1706

NPI assigned

Oct 17, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Shannon Hall Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Specialty

Physical Therapist in Private Practice

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1318809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1511308800000",
    "number": "1639454192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "58 PORTLAND RD",
            "city": "SUMMIT",
            "state": "NJ",
            "postal_code": "079013045",
            "telephone_number": "908-447-1706"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "58 PORTLAND RD",
            "city": "SUMMIT",
            "state": "NJ",
            "postal_code": "079013045",
            "telephone_number": "908-447-1706"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WELCH",
        "first_name": "SHANNON",
        "middle_name": "B",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-10-17",
        "last_updated": "2017-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305207169",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA01495000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANNON",
            "last_name": "HALL",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jennifer Weiner, P.A.
• Joseph Paul Weiner, M.D.
• Lisa Michelle Weinman, M.S.,P.T.
• Jack Sanford Weinstein, MD
• James F Weiss, PHD
• Well BL Opco LLC
• Well BL Portfolio 1 Opco LLC
• John Andrew Werring, M.D.
• Cathy M. West, PH.D.
• Paula West

• Physical Therapist in Summit, NJ
• Providers in Summit, NJ by specialty
• Physical Therapist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.