Shane Davis Physical Therapy PC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

022935 Issued in NY

Legal business name

SHANE DAVIS PHYSICAL THERAPY PC

Practice address

13040 State Route 12
Boonville, NY 13309-4942

Phone

(315) 358-4028

Fax

(315) 358-4394

NPI assigned

Feb 8, 2013

Last updated

Jun 27, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Shane Davis, DPTNPI 1033170725

Title

Physical Therapist

Phone

(315) 358-4028

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Shane Davis, P.T.

  • Physical Therapist
  • Boonville, NY
  • NPI 1033170725
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1360281600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750982400000",
    "number": "1679812747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13040 STATE ROUTE 12",
            "city": "BOONVILLE",
            "state": "NY",
            "postal_code": "133094942",
            "telephone_number": "315-358-4028",
            "fax_number": "315-358-4186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13040 STATE ROUTE 12",
            "city": "BOONVILLE",
            "state": "NY",
            "postal_code": "133094942",
            "telephone_number": "315-358-4028",
            "fax_number": "315-358-4394"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHANE DAVIS PHYSICAL THERAPY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-02-08",
        "last_updated": "2025-06-27",
        "certification_date": "2025-06-27",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "SHANE",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "315-358-4028",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "022935",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rome Memorial Hospital, Inc
• Melanie Saber, LCSW
• Donna J Salmon, SLP
• Lisa Marie Sears, DDS
• Richard Louis Sears Jr., DDS
• Sandra Denise Stoquert, LMHC
• Sunset Nursing and Rehabilitation
• The Reconciliation Center
• Renee Frances Thorp-Sudol, OTR/L
• Sheri Lee Underwood, NP

• Physical Therapist in Boonville, NY
• Providers in Boonville, NY by specialty
• Physical Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.