Active NPI
Shannon Logan Healy, PT
- Physical Therapist
- Santa Monica, CA
National Provider Identifier
1962630061
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT35550
- Practice address
- 1033 12TH St
102
Santa Monica, CA 90403 - Phone
- (310) 650-3854
- NPI assigned
- Jun 26, 2009
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT35550 | CA | Primary |
Addresses
Primary practice location
1033 12TH St
102
Santa Monica, CA 90403
Mailing address
1033 12TH St
102
Santa Monica, CA 90403
Phone (310) 650-3854
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PT35550 | Other | CA | CA LICENCE |
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 |
|---|---|---|---|
| PT35550 | CA | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Shannon Logan Healy PT | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Physical Therapist
- Santa Monica, CA
- NPI 1518260405
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1245974400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1292198400000",
"number": "1962630061",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1033 12TH ST",
"address_2": "102",
"city": "SANTA MONICA",
"state": "CA",
"postal_code": "90403",
"telephone_number": "310-650-3854"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1033 12TH ST",
"address_2": "102",
"city": "SANTA MONICA",
"state": "CA",
"postal_code": "90403",
"telephone_number": "310-650-3854"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HEALY",
"first_name": "SHANNON",
"middle_name": "LOGAN",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-06-26",
"last_updated": "2010-12-13",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "PT35550",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CA LICENCE",
"identifier": "PT35550",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Santa Monica, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.