Active NPI
Shannon Lee, PT
- Physical Therapist
- Tustin, CA
National Provider Identifier
1841772407
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 294824
- Practice address
- 13931 Carroll Way Ste B
Tustin, CA 92780-1861 - Phone
- (714) 988-8120
- Fax
- (714) 988-8119
- NPI assigned
- Aug 30, 2018
- Sex
- Female
- Sole proprietor
- No
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 Therapist | 225100000X | 294824 | CA | Primary |
Addresses
Primary practice location
13931 Carroll Way Ste B
Tustin, CA 92780-1861
Mailing address
1800 E Lambert Rd Ste 200
Brea, CA 92821-4370
Phone (714) 988-8110
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 294824 | CA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1535587200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1535587200000",
"number": "1841772407",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1800 E LAMBERT RD STE 200",
"city": "BREA",
"state": "CA",
"postal_code": "928214370",
"telephone_number": "714-988-8110",
"fax_number": "714-988-8111"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13931 CARROLL WAY STE B",
"city": "TUSTIN",
"state": "CA",
"postal_code": "927801861",
"telephone_number": "714-988-8120",
"fax_number": "714-988-8119"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "SHANNON",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-08-30",
"last_updated": "2018-08-30",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "294824",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tustin, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.