Corissa Dawn Shaw, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

1402891 Issued in KS

Practice address

414 E 8TH Ave
Hutchinson, KS 67501-1426

Phone

(620) 663-5932

NPI assigned

Oct 6, 2015

Last updated

Oct 6, 2015By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Corissa Dawn Trejo, Lahman Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1444089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1444089600000",
    "number": "1821468646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "414 E 8TH AVE",
            "city": "HUTCHINSON",
            "state": "KS",
            "postal_code": "675011426",
            "telephone_number": "620-663-5932"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "414 E 8TH AVE",
            "city": "HUTCHINSON",
            "state": "KS",
            "postal_code": "675011426",
            "telephone_number": "620-663-5932"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAW",
        "first_name": "CORISSA",
        "middle_name": "DAWN",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-10-06",
        "last_updated": "2015-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "KS",
            "license": "1402891",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CORISSA",
            "last_name": "TREJO, LAHMAN",
            "middle_name": "DAWN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jennifer Helen Serl, APRN-BC
• Erik L Severud, MD
• Lyndsay Seymour, LCMFT
• Alissar Shaban, PHARMD
• Sara Shaban, MD
• John Shaw, MD
• Shawn D Jensen DDS,PA
• Sheri Yvonne Sherrill, LMLP
• Dorothy Celeste Shope, SLP
• Keri S Shroyer, RD

• Physical Therapy Assistant in Hutchinson, KS
• Providers in Hutchinson, KS by specialty
• Physical Therapy Assistant in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2015; 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.