Individual provider Active NPI

Shawn Moulis

  • Physical Therapist
  • Georgetown, KY
National Provider Identifier
1912869207
Registry record updated Nov 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
009477 Issued in KY
Practice address
105 Lawson Dr Ste 4
Georgetown, KY 40324-9696
Phone
(502) 642-5400
Fax
(502) 642-5411
NPI assigned
Nov 25, 2025
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2025

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 009477 KY Primary

Addresses

Primary practice location

105 Lawson Dr Ste 4
Georgetown, KY 40324-9696

Mailing address

1650 Lyndon Farm CT Ste 300
Louisville, KY 40223-5005
Phone (726) 202-3039

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251229002657 KY Practitioner - Physical Therapist in Private Practice 3274029343 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2025
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1650 Lyndon Farm CT
Suite 300
Louisville, KY 40223-4029

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
009477KYMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Commonwealth Hand Therapy Physical Therapist CurrentSince Nov 24, 2025 Accepting new patients
Commonwealth Hand Therapy Physical Therapist CurrentSince Nov 24, 2025 Accepting new patients

Locations

105 Lawson Dr
Ste 4
Georgetown, KY 40324
Phone (502) 642-5400

330 Waller Ave
Ste 275
Lexington, KY 40504
Phone (859) 447-8599

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1764028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1764028800000",
    "number": "1912869207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1650 LYNDON FARM CT STE 300",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402235005",
            "telephone_number": "726-202-3039",
            "fax_number": "210-978-5592"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 LAWSON DR STE 4",
            "city": "GEORGETOWN",
            "state": "KY",
            "postal_code": "403249696",
            "telephone_number": "502-642-5400",
            "fax_number": "502-642-5411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOULIS",
        "first_name": "SHAWN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-11-25",
        "last_updated": "2025-11-25",
        "certification_date": "2025-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "KY",
            "license": "009477",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Georgetown, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.