Active NPI
Kellie Shanks
- Massage Therapist
- Port Charlotte, FL
National Provider Identifier
1689090607
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MA73679
- Practice address
- 3440 Conway Blvd
3B
Port Charlotte, FL 33952-7000 - Phone
- (941) 766-1882
- NPI assigned
- Mar 14, 2014
- 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 |
|---|---|---|---|---|
| Massage Therapist | 225700000X | MA73679 | FL | Primary |
Addresses
Primary practice location
3440 Conway Blvd
3B
Port Charlotte, FL 33952-7000
Mailing address
3440 Conway Blvd
3B
Port Charlotte, FL 33952-7000
Phone (941) 766-1882
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 |
|---|---|---|---|
| MA73679 | FL | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dower Chiropractic, Inc | Past | Accepting new patients | |
| Aker Chiropractic, Inc | Past | Accepting new patients |
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.
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- NPI 1104863182
-
- Chiropractor
- Sarasota, FL
- NPI 1851338834
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1394755200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1394755200000",
"number": "1689090607",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3440 CONWAY BLVD",
"address_2": "3B",
"city": "PORT CHARLOTTE",
"state": "FL",
"postal_code": "339527000",
"telephone_number": "941-766-1882"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3440 CONWAY BLVD",
"address_2": "3B",
"city": "PORT CHARLOTTE",
"state": "FL",
"postal_code": "339527000",
"telephone_number": "941-766-1882"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHANKS",
"first_name": "KELLIE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-03-14",
"last_updated": "2014-03-14",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "FL",
"license": "MA73679",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port Charlotte, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.