Active NPI
Shannon Grage, PT, DPT
- Orthopedic Physical Therapist
- Brockport, NY
National Provider Identifier
1790496396
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopedic Physical Therapist
- License
- 049751-01
- Practice address
- 156 West Ave
Brockport, NY 14420-1229 - Phone
- (585) 275-5321
- NPI assigned
- Dec 6, 2022
- 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 |
|---|---|---|---|---|
| Orthopedic Physical Therapist | 2251X0800X | 049751-01 | NY | Primary |
Addresses
Primary practice location
156 West Ave
Brockport, NY 14420-1229
Mailing address
156 West Ave
Brockport, NY 14420-1229
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 |
|---|---|---|---|
| 049751-01 | NY | MD | Orthopedic Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1670284800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1670284800000",
"number": "1790496396",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "156 WEST AVE",
"city": "BROCKPORT",
"state": "NY",
"postal_code": "144201229"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "156 WEST AVE",
"city": "BROCKPORT",
"state": "NY",
"postal_code": "144201229",
"telephone_number": "585-275-5321"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAGE",
"first_name": "SHANNON",
"credential": "PT, DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-12-06",
"last_updated": "2022-12-06",
"certification_date": "2022-12-06",
"status": "A"
},
"taxonomies": [
{
"code": "2251X0800X",
"taxonomy_group": "",
"desc": "Physical Therapist, Orthopedic",
"state": "NY",
"license": "049751-01",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brockport, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.