Shannan C Vincent, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

05003605A Issued in IN

Practice address

3016 Portage Ave
South Bend, IN 46628-3501

Phone

(574) 272-9011

NPI assigned

Nov 12, 2019

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 1993

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Senior Outpatient ServicesGroup PAC ID 6507264165, 10 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Senior Outpatient Services

  • Occupational Therapist
  • Elkhart, IN
  • NPI 1750050977

  Physical Therapist

  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1573516800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782777600000",
    "number": "1982249090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "686 FOREST CT",
            "city": "NAPPANEE",
            "state": "IN",
            "postal_code": "465502831",
            "telephone_number": "574-773-0207"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3016 PORTAGE AVE",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466283501",
            "telephone_number": "574-272-9011"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1220 E Jackson Blvd",
            "address_purpose": "LOCATION",
            "city": "Elkhart",
            "state": "IN",
            "postal_code": "465164419",
            "country_code": "US",
            "telephone_number": "574-333-9747",
            "fax_number": "574-367-2369",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VINCENT",
        "first_name": "SHANNAN",
        "middle_name": "C",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-11-12",
        "last_updated": "2026-06-30",
        "certification_date": "2026-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IN",
            "license": "05003605A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300032594",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Victory Clinical Services II LLC
• Anthony Vida, MD
• Jonathan Vida
• Victoria L. Vierling, M.ED., O.T.R.
• Adrian Villalobos
• Sheryl Ann Vinci, APRN
• Shiva Viswanath
• Vital Medi Nemt, LLC
• Katherine Vite
• Lani C Vivirito, LCSW

• Physical Therapist in South Bend, IN
• Providers in South Bend, IN by specialty
• Physical Therapist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.