Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jacqueline Kelly Shane, DPT

Individual provider Physical Therapist · NPI 1205721362

Jacqueline Kelly Shane, DPT is a Physical Therapist in Private Practice in Overland Park, Kansas. Qualified in 2025, 1 year ago. Practices with Dickson Diveley Midwest Orthopaedic Clinic LLC, a 68-clinician group and accepts Medicare assignment. Licensed in Kansas.

Years since qualifying
1
Licensed in
KS
In the registry since
2025
What do these letters mean?
DPT — Doctor of Physical Therapy
The doctoral degree now required to enter physical therapy practice.

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Practice location Address checks out

8889 W 75th St
Overland Park, KS 66204-2206
Phone: (913) 319-7600
Fax: (913) 253-1702
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence 11-07890 (KS)

Record details

NPI number1205721362
Entity typeIndividual (Type 1)
GenderFemale
Credentials DPT
Sole proprietorNo
NPI enumeratedJune 10, 2025
Last updated in NPPESJune 24, 2025
Certification dateJune 24, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2025 (1 years in practice)
Group practice Dickson Diveley Midwest Orthopaedic Clinic Llc — 68 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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