Keegan Douglas Shannon, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

5501303485 Issued in MI

Practice address

11160 WJ Presley Pkwy Ste 103
Allendale, MI 49401-8075

Phone

(978) 602-7431

NPI assigned

Aug 14, 2024

Sex

Male

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 MI

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Ivyrehab Michigan, LLC

  • Sports Medicine (Physical Medicine & Rehabilitation) Physician
  • Fenton, MI
  • NPI 1104337120

  Physical Therapist

  Medicare reassignment NPD
• Ivyrehab Northern PT, LLC

  • Physical Therapy Clinic/Center
  • Sparta, MI
  • NPI 1972592525
  NPD (past)

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

{
    "created_epoch": "1723593600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723593600000",
    "number": "1861224412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 419885",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022419885",
            "telephone_number": "914-294-4050",
            "fax_number": "631-760-8306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11160 WJ PRESLEY PKWY STE 103",
            "city": "ALLENDALE",
            "state": "MI",
            "postal_code": "494018075",
            "telephone_number": "978-602-7431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHANNON",
        "first_name": "KEEGAN",
        "middle_name": "DOUGLAS",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-08-14",
        "last_updated": "2024-08-14",
        "certification_date": "2024-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501303485",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Douglas Schultz, DMD
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• Aaron James Schulz, D.C.
• Jordan Kyle Seeger
• Sensory Source, LLC
• Natalie Lorraine Siwula, PA
• Haley J Slagboom, DPT
• Jessi Smith
• Solace Counseling Services
• Sonder Center for Neurodevelopment LLC

• Physical Therapist in Allendale, MI
• Providers in Allendale, MI by specialty
• Physical Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.