Nicole Dominique Jalandoni Vasquez

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT61432108 Issued in WA

Practice address

1445 Galaxy Dr NE Ste 301
Lacey, WA 98516-4754

Phone

(360) 456-1444

NPI assigned

Oct 12, 2024

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Penrose and Associates Physical Therapy LLCGroup PAC ID 1052403896, 11 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.

• Penrose & Associates Physical Therapy LLC

  • Physical Therapy Clinic/Center
  • Lacey, WA
  • NPI 1740480110
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1728691200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728691200000",
    "number": "1033939244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6462 STEAMER DR SE",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985136230",
            "telephone_number": "564-225-7309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1445 GALAXY DR NE STE 301",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985164754",
            "telephone_number": "360-456-1444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VASQUEZ",
        "first_name": "NICOLE DOMINIQUE",
        "middle_name": "JALANDONI",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-10-12",
        "last_updated": "2024-10-12",
        "certification_date": "2024-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT61432108",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julie K Vanausdal, M.S. CCC-A
• Robert Dewey Vandenberg, M.D.
• Glenda Hendrica Vanhaitsma, R.N.
• Antonio Joaquin Varela, DPT MHSC MTC
• Amy Jo Vargas, DNP, ARNP
• Lesley Fiona Vaughan, OTR/L
• Elaine Vaughn, LMHC
• Matthew S Vaughn, MFT
• VBNC Physical Therapy PLLC
• Diana E. Velikova, M.D.

• Physical Therapist in Lacey, WA
• Providers in Lacey, WA by specialty
• Physical Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2024; 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.