Carrol Shane Fortenberry, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT0345 Issued in MS

Practice address

2844 Traceland Ave.
Tupelo, MS 38801

Phone

(188) 863-9692

Fax

(662) 680-5097

NPI assigned

Nov 25, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1259107200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1259107200000",
    "number": "1659609923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2844 TRACELAND DR",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388014200",
            "telephone_number": "188-863-9692"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2844 TRACELAND AVE.",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "38801",
            "telephone_number": "188-863-9692",
            "fax_number": "662-680-5097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORTENBERRY",
        "first_name": "CARROL",
        "middle_name": "SHANE",
        "name_prefix": "Mr.",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-11-25",
        "last_updated": "2009-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MS",
            "license": "PT0345",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TN",
            "license": "PT0000008246",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dorothy Elder Ford
• Ron C Ford
• Amy M Forrest, CFNP
• Brooke Forrest, LMSW
• Lori Hall Forrester, NP
• Frank Fortenberry, MD
• Darrin Foster, MS
• Hugh James Foster
• Jack B Foster Jr., MD
• Robert Foster, NP

• Physical Therapist in Tupelo, MS
• Providers in Tupelo, MS by specialty
• Physical Therapist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2009; 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.