Active NPI
Malissa Kei Shadle, DPT
- Physical Therapist
- Glendale, CA
National Provider Identifier
1649001033
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 306540
- Practice address
- 425 E Colorado St Ste 440
Glendale, CA 91205-1675 - Phone
- (833) 477-6878
- NPI assigned
- Aug 8, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 306540 | CA | Primary |
Addresses
Primary practice location
425 E Colorado St Ste 440
Glendale, CA 91205-1675
Mailing address
425 E Colorado St Ste 440
Glendale, CA 91205-1675
Phone (833) 477-6878
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
| License | State | Type | Specialty |
|---|---|---|---|
| 306540 | CA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1723075200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1723075200000",
"number": "1649001033",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "425 E COLORADO ST STE 440",
"city": "GLENDALE",
"state": "CA",
"postal_code": "912051675",
"telephone_number": "833-477-6878"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "425 E COLORADO ST STE 440",
"city": "GLENDALE",
"state": "CA",
"postal_code": "912051675",
"telephone_number": "833-477-6878"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHADLE",
"first_name": "MALISSA",
"middle_name": "KEI",
"credential": "DPT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-08-08",
"last_updated": "2024-08-08",
"certification_date": "2024-07-27",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "306540",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glendale, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.