IndividualActive
Kevin Shaddock, DPT
NPI 1568940617 · Geriatric Physical Therapist · Ponte Vedra, FL
Provider details
- NPI number
- 1568940617
- Entity type
- Individual
- Primary specialty
- Geriatric Physical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service Providers
- Credential
- DPT
- Sex
- Male
- Sole proprietor
- Yes
- License
- PT33637 (FL)
Specialties & taxonomies
Respiratory, Developmental, Rehabilitative and Restorative Service Providers
Profile Score
Established profile(67/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
7 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
816 A1a N Ste 307
Ponte Vedra, FL 32082-3219
Phone: (402) 190-4543
Approximate (ZIP-level) locationGet directions
Mailing address
3901 University Blvd S
Jacksonville, FL 32216-4312
Registry dates
- Enumerated
- 2018-07-31
- Last updated
- 2018-07-31
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.