Active NPI
Shannon B. Ericson, MS, PT
- Physical Therapist
- Overland Park, KS
National Provider Identifier
1710941455
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 11-01600
- Practice address
- 5425 W 100TH Ter
Overland Park, KS 66207-3119 - Phone
- (913) 825-6636
- NPI assigned
- Apr 12, 2006
- Sex
- Male
- 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 | 11-01600 | KS | Primary |
Addresses
Primary practice location
5425 W 100TH Ter
Overland Park, KS 66207-3119
Mailing address
5425 W 100TH Ter
Overland Park, KS 66207-3119
Phone (913) 825-6636
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11-01600 | KS | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144800000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1184803200000",
"number": "1710941455",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5425 W 100TH TER",
"city": "OVERLAND PARK",
"state": "KS",
"postal_code": "662073119",
"telephone_number": "913-825-6636"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5425 W 100TH TER",
"city": "OVERLAND PARK",
"state": "KS",
"postal_code": "662073119",
"telephone_number": "913-825-6636"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ERICSON",
"first_name": "SHANNON",
"middle_name": "B.",
"name_prefix": "Mr.",
"credential": "MS, PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-12",
"last_updated": "2007-07-19",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "KS",
"license": "11-01600",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Overland Park, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.