Active NPI
Shawn D Axten, PT,CST-D
- Physical Therapy Clinic/Center
- Bend, OR
National Provider Identifier
1922158377
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Clinic/Center
- License
- 01557
- Practice address
- 20360 Empire Ave # B-9a
Bend, OR 97703-5709 - Phone
- (360) 607-7226
- Fax
- (541) 706-9330
- NPI assigned
- Jan 10, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Rehabilitation Medicine Physician | 2081P0010X | WAPT0000574 | WA | |
| Physical Therapy Clinic/Center | 261QP2000X | 01557 | OR | Primary |
Addresses
Primary practice location
20360 Empire Ave # B-9a
Bend, OR 97703-5709
Mailing address
PO Box 444
Bend, OR 97709-0444
Phone (360) 607-7226
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00005748 | Other | WA | WA PHYSICAL THERAPY LICENSING BOARD |
| 01557 | Other | OR | OREGON PT LICENSING BOARD |
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 |
|---|---|---|---|
| WAPT0000574 | WA | MD | Pediatric Rehabilitation Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168387200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1718755200000",
"number": "1922158377",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 444",
"city": "BEND",
"state": "OR",
"postal_code": "977090444",
"telephone_number": "360-607-7226",
"fax_number": "541-706-9330"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20360 EMPIRE AVE # B-9A",
"city": "BEND",
"state": "OR",
"postal_code": "977035709",
"telephone_number": "360-607-7226",
"fax_number": "541-706-9330"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AXTEN",
"first_name": "SHAWN",
"middle_name": "D",
"credential": "PT,CST-D",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-10",
"last_updated": "2024-06-19",
"certification_date": "2024-06-19",
"status": "A"
},
"taxonomies": [
{
"code": "2081P0010X",
"taxonomy_group": "",
"desc": "Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine",
"state": "WA",
"license": "WAPT0000574",
"primary": false
},
{
"code": "261QP2000X",
"taxonomy_group": "",
"desc": "Clinic/Center, Physical Therapy",
"state": "OR",
"license": "01557",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WA PHYSICAL THERAPY LICENSING BOARD",
"identifier": "00005748",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OREGON PT LICENSING BOARD",
"identifier": "01557",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bend, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.