Active NPI
Shane Vidal
- Physical Therapy Assistant
- Northridge, CA
National Provider Identifier
1831903905
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 53866
- Practice address
- 11260 Wilbur Ave Ste 101
Northridge, CA 91326-2450 - Phone
- (818) 832-5656
- Fax
- (818) 838-5245
- NPI assigned
- Feb 6, 2025
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 53866 | CA | Primary |
Addresses
Primary practice location
11260 Wilbur Ave Ste 101
Northridge, CA 91326-2450
Mailing address
22003 Liggett St
Chatsworth, CA 91311-5721
Phone (818) 534-6199
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 |
|---|---|---|---|
| 53866 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1738800000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1738800000000",
"number": "1831903905",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22003 LIGGETT ST",
"city": "CHATSWORTH",
"state": "CA",
"postal_code": "913115721",
"telephone_number": "818-534-6199"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11260 WILBUR AVE STE 101",
"city": "NORTHRIDGE",
"state": "CA",
"postal_code": "913262450",
"telephone_number": "818-832-5656",
"fax_number": "818-838-5245"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VIDAL",
"first_name": "SHANE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2025-02-06",
"last_updated": "2025-02-06",
"certification_date": "2025-02-06",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "CA",
"license": "53866",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Northridge, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.