Provider Demographics
NPI:1962732552
Name:SHOCK, JENNIFER NICHOLE (DPT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:NICHOLE
Last Name:SHOCK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:NICHOLE
Other - Last Name:GEISSERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2813 SW ANCASTER RD
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-4729
Mailing Address - Country:US
Mailing Address - Phone:785-342-9801
Mailing Address - Fax:
Practice Address - Street 1:2813 SW ANCASTER RD
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-4729
Practice Address - Country:US
Practice Address - Phone:785-342-9801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-05
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-03946225100000X
MO2009022125225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS176546Medicare PIN