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KEVIN SHADDOCK DPT
NPI 1568940617
Physical Therapist - Geriatrics in Ponte Vedra, FL

Active since July 31, 2018
816 A1A N STE 307, PONTE VEDRA, FL 32082(402) 190-4543 Get Directions Write a Review

NPPES record last updated: July 31, 2018. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Kevin Shaddock Dpt NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KEVIN SHADDOCK DPT (NPI 1568940617) is an individual geriatrics provider in Ponte Vedra, Florida, licensed in Florida (PT33637) and active in the NPI registry since July 2018.

NPPES Registry Identity

NPI1568940617
Entity TypeIndividualMale
Primary Taxonomy2251G0304X
Provider Legal NameKEVIN SHADDOCKCredential: DPT
Location Address816 A1A N STE 307Ponte Vedra, FL 32082-3219
Mailing Address3901 University Blvd SJacksonville, FL 32216-4312 · (904) 345-7336
Phone(402) 190-4543
Sole ProprietorYes
Enumeration DateJuly 31, 2018
✔ NPI 1568940617 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysical Therapist · GeriatricsRespiratory, Developmental, Rehabilitative and Restorative Service Providers
Taxonomy Code2251G0304X
License✔ Licensed in FL · PT33637
Definition
A licensed physical therapist, including but not limited to an individual who is a Board Certified Specialist in Geriatric Physical Therapy, who has demonstrated specialized knowledge and skill in the comprehensive biopsychosocial assessment and evidence-based management of movement in aging adults. This includes, but is not limited to, specialized knowledge in and consideration of normal age-related changes and pathological manifestations across all systems; cognition and mental health; polypharmacy; fall risk mitigation; bone health; healthy and active aging, and socioeconomic and health policy issues affecting aging adults. The geriatric physical therapist is an integral part of the interdisciplinary geriatric team and serves as an advocate for the highest level of well-being for the older adult.
816 A1A N STE 307, Ponte Vedra, FL 32082
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kevin Shaddock Dpt is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Billing Reassignments

3

Medicare enrollment records show Kevin Shaddock reassigns Medicare billing to 3 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Orthopedic And Sports Physical Therapy Services, Inc.
758 mi
Physical Therapist
420 BAINBRIDGE ST
Philadelphia, PA 19147
  • Reassigned Medicare billing, Pennsylvania enrollment
  • 334 clinicians in this Medicare group
NPI 1588661235 (215) 629-1270
Progress Physical Therapy LLC
767 mi
Physical Therapist
8015 FRANKFORD AVE
Philadelphia, PA 19136
  • Reassigned Medicare billing, Pennsylvania enrollment
  • 550 clinicians in this Medicare group
NPI 1164851085 (914) 294-4050
Pennsylvania Luna Care Physical Therapy LLC
771 mi
Physical Therapist
300 WELSH RD STE 100
Horsham, PA 19044
  • Reassigned Medicare billing, Pennsylvania enrollment
  • 136 clinicians in this Medicare group
NPI 1528689445 (866) 525-3175

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KALEB DANIEL THOMAS
Physical Therapist
816 A1A N STE 307
PONTE VEDRA BEACH, FL 32082
St. Johns County (904) 543-4021
JUSTIN ANDREW ZYCH PT, DPT
Physical Therapist
816 A1A N STE 307
PONTE VEDRA BEACH, FL 32082
St. Johns County (904) 543-4021
SARAH POE PT, DPT
Physical Therapist
816 A1A N STE 307
PONTE VEDRA, FL 32082
St. Johns County (904) 543-4021
MITCHELL JOHNSON
Physical Therapist
816 A1A N STE 307
PONTE VEDRA, FL 32082
St. Johns County (904) 543-4021

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kevin Shaddock's NPI number?

The NPI number for Kevin Shaddock is 1568940617. It was assigned to this individual provider in the NPPES registry on July 31, 2018.

Where is Kevin Shaddock located?

Kevin Shaddock practices at 816 A1a N Ste 307, Ponte Vedra, FL 32082. The listed phone number is (402) 190-4543.

What is Kevin Shaddock's specialty?

The primary specialty registered for this NPI is Physical Therapist, specializing in Geriatrics, with taxonomy code 2251G0304X.

Is Kevin Shaddock enrolled in Medicare?

Yes. Kevin Shaddock is registered in the Medicare PECOS enrollment system.

Which organizations bill Medicare for Kevin Shaddock's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Kevin Shaddock reassigns Medicare benefits to 3 organizations: Orthopedic And Sports Physical Therapy Services, Inc. (Philadelphia, PA), Progress Physical Therapy LLC (Philadelphia, PA) and Pennsylvania Luna Care Physical Therapy LLC (Horsham, PA). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Kevin Shaddock's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Kevin Shaddock was last updated on July 31, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.