Shantay Anderson

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA-6180 Issued in ID

Practice address

527 Memorial Dr
Pocatello, ID 83201-4063

Phone

(208) 478-3333

NPI assigned

Apr 15, 2020

Sex

Female

Sole proprietor

No

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Apr 15, 2020.

{
    "created_epoch": "1586908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586908800000",
    "number": "1942829205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5277 STUART AVE",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832022201",
            "telephone_number": "208-760-7975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "527 MEMORIAL DR",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832014063",
            "telephone_number": "208-478-3333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "SHANTAY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-15",
        "last_updated": "2020-04-15",
        "certification_date": "2020-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "UT",
            "license": "11433285-2402",
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "ID",
            "license": "PTA-6180",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matthew Anderson, PA
• Michael A Anderson, DO
• Morgan Newel Anderson, D.O.
• Natalie Anderson
• Rylan Anderson, DO
• David Anderton
• Josie Andreski
• Andrew Stoddard Dental Services, PLLC
• Kimberly Jo Andrew, LCPC
• Anesthesia Associates of Pocatello, PA

• All providers in Pocatello, ID
• Physical Therapy Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.