Active NPI
Nicole Anderson
- Physical Therapist
- Fort Walton Beach, FL
National Provider Identifier
1013024595
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- Practice address
- 928 Mar Walt Drive
Ste 104
Fort Walton Beach, FL 32547 - Phone
- (850) 863-4747
- NPI assigned
- Aug 23, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | Primary |
Addresses
Primary practice location
928 Mar Walt Drive
Ste 104
Fort Walton Beach, FL 32547
Mailing address
9680 Seafarers Way
Navarre, FL 32566-2849
Phone (850) 936-8306
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PT22005 | Other | FL | LICENSE # |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156291200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1013024595",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9680 SEAFARERS WAY",
"city": "NAVARRE",
"state": "FL",
"postal_code": "325662849",
"telephone_number": "850-936-8306"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "928 MAR WALT DRIVE",
"address_2": "STE 104",
"city": "FORT WALTON BEACH",
"state": "FL",
"postal_code": "32547",
"telephone_number": "850-863-4747"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSON",
"first_name": "NICOLE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-23",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE #",
"identifier": "PT22005",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Walton Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.