Shaina Beth Clemons, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

23318 Issued in MD

Practice address

2130 Priest Bridge Dr
Suite 2
Crofton, MD 21114-2457

Phone

(410) 721-6333

Fax

(410) 721-7651

NPI assigned

Jul 29, 2011

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

Medicare fee-for-service enrollment

Enrolled in MD

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Breakaway Physical Therapy, LLCGroup PAC ID 8123330222, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Breakaway Physical Therapy, LLC

  • Physical Therapist
  • Crofton, MD
  • NPI 1780077784
  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1311897600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1490832000000",
    "number": "1821376567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4704",
            "city": "CROFTON",
            "state": "MD",
            "postal_code": "211144704",
            "telephone_number": "410-721-6333",
            "fax_number": "410-721-7651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2130 PRIEST BRIDGE DR",
            "address_2": "SUITE 2",
            "city": "CROFTON",
            "state": "MD",
            "postal_code": "211142457",
            "telephone_number": "410-721-6333",
            "fax_number": "410-721-7651"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLEMONS",
        "first_name": "SHAINA",
        "middle_name": "BETH",
        "name_prefix": "Mrs.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-07-29",
        "last_updated": "2017-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MD",
            "license": "23318",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katherine Childers
• Nana Choi
• Kate Chowpaknam, PSYD
• Carrie Ann Moritz Clancy, AU.D.
• Erin Greer Clark, M.S. CCC-SLP
• Michele Coakley
• Terrence R Coger
• Elise Marie Coggins, OTR/L
• Jacqueline Cohen, PSYD
• Christina Cole

• Physical Therapist in Crofton, MD
• Providers in Crofton, MD by specialty
• Physical Therapist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.