Individual provider Active NPI

Sofia Shannon

  • Physical Therapist
  • Medford, NJ
National Provider Identifier
1669359303
Registry record updated Aug 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Practice address
200 Tuckerton Rd
Medford, NJ 08055-8806
Phone
(856) 347-3464
NPI assigned
Aug 15, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X Primary

Addresses

Primary practice location

200 Tuckerton Rd
Medford, NJ 08055-8806

Mailing address

206 Poplar Ave
Evesham, NJ 08053-7136

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251014001247 NJ Practitioner - Physical Therapist in Private Practice 3476040528 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Twin Boro Physical Therapy Associates, PAGroup PAC ID 8527962950, 89 clinicians

Practice addresses (Care Compare)

200 Tuckerton Rd
Suite 17
Medford, NJ 08055-8806
Phone (856) 396-2250

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Twin Boro Physical Therapy Associates PA Physical Therapist CurrentSince Sep 2, 2025 Accepting new patients
Twin Boro Physical Therapy Associates, PA CurrentSince Sep 2, 2025 Accepting new patients

Locations

20 Commerce Dr
Ste 210
Cranford, NJ 07016

200 Tuckerton Rd
Ste 17
Medford, NJ 08055
Phone (856) 396-2250

2050 State Route 27
Ste 107
North Brunswick, NJ 08902
Phone (732) 745-2727

1124 South Ave W
Westfield, NJ 07090
Phone (908) 212-9711

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1755216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755216000000",
    "number": "1669359303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "206 POPLAR AVE",
            "city": "EVESHAM",
            "state": "NJ",
            "postal_code": "080537136"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 TUCKERTON RD",
            "city": "MEDFORD",
            "state": "NJ",
            "postal_code": "080558806",
            "telephone_number": "856-347-3464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHANNON",
        "first_name": "SOFIA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-08-15",
        "last_updated": "2025-08-15",
        "certification_date": "2025-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Medford, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2025; 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.