Kimberly Larue Kwan Shackelford, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

40045 Issued in CA

Practice address

3601 Marconi Ave
Sacramento, CA 95821-5309

Phone

(916) 481-1300

NPI assigned

Sep 24, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Kimberly Larue Kwan Asato Former name

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Capuchino Therapy Group

  • Speech-Language Pathologist
  • Sacramento, CA
  • NPI 1568538064
  Medicare reassignment
• Laguna Physical Therapy & Hand Rehabilitation

  • Physical Therapist
  • Elk Grove, CA
  • NPI 1912043993
  NPD

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

{
    "created_epoch": "1348444800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1425945600000",
    "number": "1760733356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3171 RANCHO SILVA DR",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958331132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3601 MARCONI AVE",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958215309",
            "telephone_number": "916-481-1300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHACKELFORD",
        "first_name": "KIMBERLY",
        "middle_name": "LARUE KWAN",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-24",
        "last_updated": "2015-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1221081",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "40045",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "ASATO",
            "middle_name": "LARUE KWAN",
            "credential": "DPT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Salma Shabaik, M.D.
• Malaika Shaban, RBT
• Fatima Shabazz
• George Kenyon Shabazz
• Hassan Shabazz
• Samantha J Shackelford
• Sandra Shackelford
• Alexandria Shacoski
• Amir Shad, DDS
• Bushra Shad

• Physical Therapist in Sacramento, CA
• Providers in Sacramento, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2015; 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.