Shane Thoreson, MPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

2013040780 Issued in MO

Practice address

4800 Mexico Rd
Suite 104
Saint Peters, MO 63376-1666

Phone

(636) 939-9540

Fax

(636) 939-9886

NPI assigned

Jun 2, 2010

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Interoperability endpoints

• Direct secure messaging: sthoreson55790@direct.med.utah.edu
• Direct secure messaging: shane.thoreson.1@16923.direct.athenahealth.com

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

{
    "created_epoch": "1275436800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639699200000",
    "number": "1639499650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2454 W CLAY ST",
            "city": "SAINT CHARLES",
            "state": "MO",
            "postal_code": "633012548",
            "telephone_number": "636-916-4625",
            "fax_number": "636-916-4628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4800 MEXICO RD",
            "address_2": "SUITE 104",
            "city": "SAINT PETERS",
            "state": "MO",
            "postal_code": "633761666",
            "telephone_number": "636-939-9540",
            "fax_number": "636-939-9886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THORESON",
        "first_name": "SHANE",
        "credential": "MPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-06-02",
        "last_updated": "2021-12-17",
        "certification_date": "2021-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MO",
            "license": "2013040780",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "STHORESON55790@DIRECT.MED.UTAH.EDU",
            "affiliation": "Y",
            "affiliationName": "University of Utah",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "50 N Medical Dr",
            "city": "Salt Lake City",
            "state": "UT",
            "country_code": "US",
            "postal_code": "841320001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Thripura Thirtala, M.D.
• Linda Thomas
• Kara D Thompson, OTR
• Keith David Thompson, PHARMD
• Robert Weldon Thompson II, DDS
• Kelly Thornton, PT
• Rashonda Thornton, LPC
• Thrive Enrich Empower LLC
• Kayla Arnee Tiller, FNP-C
• Timothy a. Schaible D.M.D and Associates LLC

• Physical Therapist in Saint Peters, MO
• Providers in Saint Peters, MO by specialty
• Physical Therapist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2021; 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.