Active NPI
Shannon Bodilly, PT, DPT
- Physical Therapist
- Melbourne, FL
National Provider Identifier
1770263147
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT40330
- Practice address
- 4241 N US Highway 1
Melbourne, FL 32935-4822 - Phone
- (833) 684-5439
- NPI assigned
- Jul 20, 2023
- 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 | PT40330 | FL | Primary |
Addresses
Primary practice location
4241 N US Highway 1
Melbourne, FL 32935-4822
Mailing address
9004 N Park Plaza CT
Brown Deer, WI 53223-2124
Phone (920) 393-0239
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 |
|---|---|---|---|
| PT40330 | FL | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1689811200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1689811200000",
"number": "1770263147",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9004 N PARK PLAZA CT",
"city": "BROWN DEER",
"state": "WI",
"postal_code": "532232124",
"telephone_number": "920-393-0239"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4241 N US HIGHWAY 1",
"city": "MELBOURNE",
"state": "FL",
"postal_code": "329354822",
"telephone_number": "833-684-5439"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BODILLY",
"first_name": "SHANNON",
"credential": "PT, DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-07-20",
"last_updated": "2023-07-20",
"certification_date": "2023-07-20",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "FL",
"license": "PT40330",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Melbourne, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.