Individual provider Active NPI

Shannon Sheckels, PT

  • Physical Therapist
  • Eldersburg, MD
National Provider Identifier
1902806896
Registry record updated Sep 20, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
18634 Issued in MD
Practice address
1207 Liberty Rd Ste 106
Eldersburg, MD 21784-6574
Phone
(410) 549-5700
Fax
(410) 549-6200
NPI assigned
Jul 21, 2005
Last updated
Sep 20, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 18634 MD Primary

Addresses

Primary practice location

1207 Liberty Rd Ste 106
Eldersburg, MD 21784-6574

Mailing address

350 New Fidelity CT
Garner, NC 27529-2665
Phone (919) 258-2714

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180323000744 MD Practitioner - Physical Therapist in Private Practice 1052673464 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
18634MDMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Lifebridge Sports Medicine & Rehabilitation LLC CurrentSince Sep 1, 2020 Accepting new patients
Maryland Sportscare & Rehab LLC Physical Therapist CurrentSince Jan 3, 2018 Accepting new patients
Lifebridge Sports Medicine and Rehabilitation LLC Current Accepting new patients
Lifebridge Sports Medicine & Rehabilitation, LLC CurrentSince Sep 1, 2020 Accepting new patients
Maryland Sportscare & Rehab, LLC Physical Therapist CurrentSince Jan 3, 2018 Accepting new patients
Fall Prevention and Stroke Rehab Physician, LLC CurrentSince Sep 1, 2024 Accepting new patients

Locations

1207 Liberty Rd
Ste 106
Eldersburg, MD 21784
Phone (410) 549-5600

9199 Reisterstown Rd
Ste 101B
Owings Mills, MD 21117
Phone (443) 543-6773

25 Main St
Ste A
Reisterstown, MD 21136
Phone (410) 833-8300

41 Magna Way
Ste 140
Westminster, MD 21157
Phone (443) 487-6614

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1121904000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537401600000",
    "number": "1902806896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 NEW FIDELITY CT",
            "city": "GARNER",
            "state": "NC",
            "postal_code": "275292665",
            "telephone_number": "919-258-2714",
            "fax_number": "410-648-4878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1207 LIBERTY RD STE 106",
            "city": "ELDERSBURG",
            "state": "MD",
            "postal_code": "217846574",
            "telephone_number": "410-549-5700",
            "fax_number": "410-549-6200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHECKELS",
        "first_name": "SHANNON",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-21",
        "last_updated": "2018-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MD",
            "license": "18634",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eldersburg, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2018; 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.