Nicolas Bereciartua
Individual provider Active NPI Physical Therapist · Jefferson, LA
NPI 1043036601 · NPPES record last updated Nov 28, 2024
Key facts
- NPI
- 1043036601
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- Practice address
- 101 River Rd Ste 112
Jefferson, LA 70121-4226 - Phone
- (504) 828-7696
- NPI assigned
- Nov 28, 2024
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2024
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Crane Rehab Center LLC
Practice addresses (Care Compare)
101 River Rd
Suite 112
Jefferson, LA 70121-4226
Phone (504) 828-7696
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250116000475 | LA | Practitioner - Physical Therapist in Private Practice | 1951839158 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Crane Rehab Center LLC | Current |
Accepting new patients | |
| Crane Rehab Center LLC | Physical Therapist | Past |
Accepting new patients |
| Crane Rehab Center | Past | Accepting new patients |
Locations
101 River Rd
Ste 112
New Orleans, LA 70121
Phone (504) 828-7696
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | Yes |
Addresses
Primary practice location
101 River Rd Ste 112
Jefferson, LA 70121-4226
Mailing address
101 River Rd Ste 112
Jefferson, LA 70121-4226
Phone (504) 828-7696
Other providers in Jefferson, LA
- Aaron R Beckner
- Miriam Ferrand Becnel
- Samantha Elizabeth Beland
- David Benhuri
- Matthew Bennett
- Caroline Bereuter
- Jeffrey Berger Jr.
- Mary Bergeron
- Erin Michelle Berni
- Elliott Berry
All providers in Jefferson, LA · Physical Therapist in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 28, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.