Active NPI
Shannon L. Nelson, P.T.
- Physical Therapist
- Gallup, NM
National Provider Identifier
1699941062
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 3051
- Practice address
- 516 E. Nizhoni Blvd.
Gallup, NM 87301-1337 - Phone
- (505) 722-1000
- Fax
- (505) 722-1226
- NPI assigned
- May 5, 2008
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 3051 | NM | Primary |
Addresses
Primary practice location
516 E. Nizhoni Blvd.
Gallup, NM 87301-1337
Mailing address
P.O. Box 1337
Gallup, NM 87305-1337
Phone (505) 722-1000
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3051 | NM | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1209945600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1343347200000",
"number": "1699941062",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O. BOX 1337",
"city": "GALLUP",
"state": "NM",
"postal_code": "873051337",
"telephone_number": "505-722-1000",
"fax_number": "505-722-1226"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "516 E. NIZHONI BLVD.",
"city": "GALLUP",
"state": "NM",
"postal_code": "873011337",
"telephone_number": "505-722-1000",
"fax_number": "505-722-1226"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NELSON",
"first_name": "SHANNON",
"middle_name": "L.",
"name_prefix": "Miss",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-05-05",
"last_updated": "2012-07-27",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NM",
"license": "3051",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gallup, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.