Shannon Elizabeth Vandevelde, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT24063 Issued in CA

Practice address

205 N Hermosa Ave
Sierra Madre, CA 91024-1731

Phone

(626) 840-6384

Fax

(626) 836-0612

NPI assigned

Jun 22, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• On the Move Physical Therapy, P.C.

  • Physical Therapist
  • Sierra Madre, CA
  • NPI 1760428304
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1150934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1649216011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 N HERMOSA AVE",
            "city": "SIERRA MADRE",
            "state": "CA",
            "postal_code": "910241731",
            "telephone_number": "626-840-6384",
            "fax_number": "626-836-0612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 N HERMOSA AVE",
            "city": "SIERRA MADRE",
            "state": "CA",
            "postal_code": "910241731",
            "telephone_number": "626-840-6384",
            "fax_number": "626-836-0612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDEVELDE",
        "first_name": "SHANNON",
        "middle_name": "ELIZABETH",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT24063",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Catherine Trzeciak, M.S.
• Katherine Tse, MA
• Miguel Antonio Ulloa
• Connie Vaillancourt
• Kendra Dawn Valdez, LCSW
• Casey Vongphrachanh
• Julie Rommen Whipple, PHD
• Michael K Williams, P.T.
• Jacque Wiswell, BCBA
• Wound Care Partners, LLC

• Physical Therapist in Sierra Madre, CA
• Providers in Sierra Madre, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.