Shane C Carpenter, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

35208 Issued in CA

Practice address

2033 San Elijo Ave
#111
Cardiff, CA 92007-1726

Phone

(831) 419-8856

NPI assigned

Jan 30, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Water'S Edge Physical Therapy and Wellness, Inc.

  • Physical Therapy Clinic/Center
  • Encinitas, CA
  • NPI 1679906242
  NPD (past) Authorized official
• Peak Performance Therapy, P.C.

  • Physical Therapy Clinic/Center
  • Telluride, CO
  • NPI 1447263686
  NPD (past)

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

{
    "created_epoch": "1233273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649721600000",
    "number": "1992943823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2033 SAN ELIJO AVE # 111",
            "city": "CARDIFF",
            "state": "CA",
            "postal_code": "920071726",
            "telephone_number": "760-557-0760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2033 SAN ELIJO AVE",
            "address_2": "#111",
            "city": "CARDIFF",
            "state": "CA",
            "postal_code": "920071726",
            "telephone_number": "831-419-8856"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARPENTER",
        "first_name": "SHANE",
        "middle_name": "C",
        "name_prefix": "Mrs.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-01-30",
        "last_updated": "2022-04-12",
        "certification_date": "2022-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "35208",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Blue Water Physical Therapy
• Laura Anne Bowman
• Boyd-Olson Chiropractic
• Robin Leslie Boyd, D.C.
• Melissa Ann Browne
• Danielle Claus, OTR
• Casandra Minerva Correa, CPS
• Donna Guadalupe Cruz
• Ainoa Cuberos
• Charles K Dashe, M.D.

• Physical Therapist in Cardiff, CA
• Providers in Cardiff, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 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.

Verify at the official NPI Registry.