Shannon Kathleen Richardson, PT, DPT, NCS, MBA

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT021322 Issued in PA

Practice address

1923 Bainbridge St
Philadelphia, PA 19146-1430

Phone

(215) 469-1832

NPI assigned

Jun 6, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Shannon Kathleen Marriner Former name

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Business Administration

State licenses

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.

• Welcome Home Wellness LLC

  • Physical Therapist
  • Philadelphia, PA
  • NPI 1407477953
  Medicare reassignment

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

{
    "created_epoch": "1622937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622937600000",
    "number": "1801463120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 30532",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191038532",
            "telephone_number": "215-469-1832"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1923 BAINBRIDGE ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191461430",
            "telephone_number": "215-469-1832"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RICHARDSON",
        "first_name": "SHANNON",
        "middle_name": "KATHLEEN",
        "credential": "PT, DPT, NCS, MBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-06",
        "last_updated": "2021-06-06",
        "certification_date": "2021-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "PA",
            "license": "PT021322",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANNON",
            "last_name": "MARRINER",
            "middle_name": "KATHLEEN",
            "credential": "PT, DPT, NCS, MBA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jasmine Richardson
• La'Tanya Richardson
• Leslie Richardson
• Patricia Richardson
• Sarah Inver Richardson, PSYD
• Sherri Richardson
• Thomas B Richardson, DO
• Troy Donovan Richardson
• Veronica Richardson, CRNP
• Debra Richberg-Warren

• Physical Therapist in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Physical Therapist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2021; 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.