Shayne Nicole Willis Baker, PT, DPT, ATC, CIMT

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

5021 Issued in OR

Practice address

3303 S Bond Ave
Portland, OR 97239-4501

Phone

(503) 494-3151

NPI assigned

Feb 18, 2009

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

• Shayne Nicole Willis Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1234915200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591488000000",
    "number": "1821237652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3303 S BOND AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972394501",
            "telephone_number": "503-494-3151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3303 S BOND AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972394501",
            "telephone_number": "503-494-3151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS BAKER",
        "first_name": "SHAYNE",
        "middle_name": "NICOLE",
        "credential": "PT, DPT, ATC, CIMT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-02-18",
        "last_updated": "2020-06-07",
        "certification_date": "2020-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "OR",
            "license": "5021",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHAYNE",
            "last_name": "WILLIS",
            "middle_name": "NICOLE",
            "credential": "PT, DPT, ATC, CIMT",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Brianna Williford, LMSW
• Nicole Williford, BCBA
• John Williksen
• Danielle Christine Willingham
• Maria Lynn Williquette, MA
• Willis Wellness Therapy, LLC
• Evening Willis-Cash, LCSW
• Alexondra Willis, MA
• Anne M Willis, PSYD
• Dale Michael Willis, M.D.

• Physical Medicine & Rehabilitation Physician in Portland, OR
• Providers in Portland, OR by specialty
• Physical Medicine & Rehabilitation Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.