Active NPI
Shannon Herold
- Physical Therapist
- Columbus, GA
National Provider Identifier
1972092443
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT014992
- Practice address
- 2045 Centre Stone CT Ste B
Columbus, GA 31904-4561 - Phone
- (706) 507-3794
- Fax
- (706) 507-3681
- NPI assigned
- May 9, 2018
- Last updated
- Nov 21, 2022
- 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 | PT014992 | GA | Primary |
Addresses
Primary practice location
2045 Centre Stone CT Ste B
Columbus, GA 31904-4561
Mailing address
3912 Essex Heights TRL
Fortson, GA 31808-6979
Phone (706) 992-9366
Other practice location 1
324 Sutton Rd SE Ste B
Owens Cross Roads, AL 35763-9412
Phone (256) 288-0045
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 |
|---|---|---|---|
| PT014992 | GA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1525824000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1668988800000",
"number": "1972092443",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3912 ESSEX HEIGHTS TRL",
"city": "FORTSON",
"state": "GA",
"postal_code": "318086979",
"telephone_number": "706-992-9366"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2045 CENTRE STONE CT STE B",
"city": "COLUMBUS",
"state": "GA",
"postal_code": "319044561",
"telephone_number": "706-507-3794",
"fax_number": "706-507-3681"
}
],
"practiceLocations": [
{
"address_1": "324 Sutton Rd SE Ste B",
"address_purpose": "LOCATION",
"city": "Owens Cross Roads",
"state": "AL",
"postal_code": "357639412",
"country_code": "US",
"telephone_number": "256-288-0045",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "HEROLD",
"first_name": "SHANNON",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-05-09",
"last_updated": "2022-11-21",
"certification_date": "2022-11-21",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "GA",
"license": "PT014992",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Columbus, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.