Individual provider Active NPI

Shelley Ankerholz, PTA

  • Physical Therapy Assistant
  • Lake Mary, FL
National Provider Identifier
1639624695
Registry record updated Aug 19, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
License
PTA26801 Issued in FL
Practice address
934 Williston Park PT Ste 1020
Lake Mary, FL 32746-2165
Phone
(407) 829-7311
NPI assigned
Aug 19, 2016
Last updated
Aug 19, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X PTA26801 FL Primary

Addresses

Primary practice location

934 Williston Park PT Ste 1020
Lake Mary, FL 32746-2165

Mailing address

1452 Foxtail CT
Lake Mary, FL 32746-4467
Phone (407) 463-1133

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
PTA26801FLMDPhysical Therapy Assistant

NPI Registry JSON

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

{
    "created_epoch": "1471564800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1471564800000",
    "number": "1639624695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1452 FOXTAIL CT",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327464467",
            "telephone_number": "407-463-1133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "934 WILLISTON PARK PT STE 1020",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327462165",
            "telephone_number": "407-829-7311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANKERHOLZ",
        "first_name": "SHELLEY",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-19",
        "last_updated": "2016-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "FL",
            "license": "PTA26801",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Mary, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2016; 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.