Active NPI
Shannon Kristine Pemble
- Physical Therapist
- Charlevoix, MI
National Provider Identifier
1942701909
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 5501010622
- Practice address
- 14700 Lake Shore Drive
Rehab Dept
Charlevoix, MI 49720 - Phone
- (231) 547-8630
- Fax
- (231) 547-8078
- NPI assigned
- Feb 26, 2018
- Sex
- Female
- Sole proprietor
- No
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 | 5501010622 | MI | Primary |
Addresses
Primary practice location
14700 Lake Shore Drive
Rehab Dept
Charlevoix, MI 49720
Mailing address
14700 Lake Shore Drive
Rehab Dept
Charlevoix, MI 49720
Phone (231) 547-8630
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 |
|---|---|---|---|
| 5501010622 | MI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1519603200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1519603200000",
"number": "1942701909",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14700 LAKE SHORE DRIVE",
"address_2": "REHAB DEPT",
"city": "CHARLEVOIX",
"state": "MI",
"postal_code": "49720",
"telephone_number": "231-547-8630",
"fax_number": "231-547-8078"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14700 LAKE SHORE DRIVE",
"address_2": "REHAB DEPT",
"city": "CHARLEVOIX",
"state": "MI",
"postal_code": "49720",
"telephone_number": "231-547-8630",
"fax_number": "231-547-8078"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEMBLE",
"first_name": "SHANNON",
"middle_name": "KRISTINE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-02-26",
"last_updated": "2018-02-26",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MI",
"license": "5501010622",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charlevoix, MI
- Leah Marie Parra, LMSW
- Celia Partida Kelly, MA,LPC,CAADC,CTP,EMD
- Matthew William Pawlick, DDS
- Viviana Vagalau Pawlick, DDS
- Arvin Jay Pearlman, JURIS DOCTOR, CCAR
- Tanesha Pfeifer, LMSW
- Pine River Medical Associates, P.C.
- Pine River Psychological Services PLLC
- Debra Jean Pluim, CNM
- Porter & Associates DDS PC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.