Active NPI
Shane A. Vath, SHANE VATH, DSC PT
- Physical Therapist
- Annapolis, MD
National Provider Identifier
1912067760
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT013186L
- Practice address
- 695 Kinkaid Rd
Annapolis, MD 21402-1006 - Phone
- (410) 293-7981
- NPI assigned
- Dec 11, 2006
- Last updated
- Oct 27, 2022
- 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 Therapist | 225100000X | PT013186L | PA | Primary |
Addresses
Primary practice location
695 Kinkaid Rd
Annapolis, MD 21402-1006
Mailing address
695 Kinkaid Rd
Annapolis, MD 21402-1006
Phone (410) 293-7907
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 |
|---|---|---|---|
| PT013186L | PA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165795200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1666828800000",
"number": "1912067760",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "695 KINKAID RD",
"city": "ANNAPOLIS",
"state": "MD",
"postal_code": "214021006",
"telephone_number": "410-293-7907"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "695 KINKAID RD",
"city": "ANNAPOLIS",
"state": "MD",
"postal_code": "214021006",
"telephone_number": "410-293-7981"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VATH",
"first_name": "SHANE",
"middle_name": "A.",
"name_prefix": "Mr.",
"credential": "SHANE VATH, DSC PT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-11",
"last_updated": "2022-10-27",
"certification_date": "2022-10-27",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "PA",
"license": "PT013186L",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Annapolis, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.