Nicholas Scott Dolezal, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

LPT-32019 Issued in AZ

Practice address

3003 Hway 95 Ste 61
Bullhead City, AZ 86442-7896

Phone

(928) 440-6880

NPI assigned

Sep 27, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Humpal Chiropractic, LLCGroup PAC ID 5496013419, 4 clinicians

Cortlyn Therapy PCGroup PAC ID 8729495684, 141 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Cortlyn Therapy, PC

  • Physical Therapist
  • Cincinnati, OH
  • NPI 1235725730

  IA

  Medicare reassignment Care Compare group NPD
• Humpal Chiropractic, LLC

  • Health Service Clinic/Center
  • North Liberty, IA
  • NPI 1992219323
  Medicare reassignment Care Compare group NPD
• Northern Arizona Physical Therapy Associates

  • Physical Therapist
  • Bullhead City, AZ
  • NPI 1871079830
  NPD (past)

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

{
    "created_epoch": "1632700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632700800000",
    "number": "1003587270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3003 HWAY 95 STE 61",
            "city": "BULLHEAD CITY",
            "state": "AZ",
            "postal_code": "864427896",
            "telephone_number": "928-440-6880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3003 HWAY 95 STE 61",
            "city": "BULLHEAD CITY",
            "state": "AZ",
            "postal_code": "864427896",
            "telephone_number": "928-440-6880"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2404 N Stockton Hill Rd Ste K",
            "address_purpose": "LOCATION",
            "city": "Kingman",
            "state": "AZ",
            "postal_code": "864014184",
            "country_code": "US",
            "telephone_number": "928-440-6880",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DOLEZAL",
        "first_name": "NICHOLAS",
        "middle_name": "SCOTT",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-09-27",
        "last_updated": "2021-09-27",
        "certification_date": "2021-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AZ",
            "license": "LPT-32019",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARIZONA STATE LICENSE",
            "identifier": "LPT-32019",
            "state": "AZ"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "nazpta.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2404 N Stockton Hill Rd Ste K",
            "city": "Kingman",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "864014184",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Physical Therapist in Bullhead City, AZ
• Providers in Bullhead City, AZ by specialty
• Physical Therapist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.