Nicholas Cacicedo, DPT
Individual provider Active NPI Physical Therapist · Allen Park, MI
NPI 1043073331 · NPPES record last updated Oct 2, 2024
Key facts
- NPI
- 1043073331
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 5501303520 (MI)
- Practice address
- 16000 Southfield Rd
Allen Park, MI 48101-2563 - Phone
- (313) 359-8867
- Fax
- (313) 359-8868
- NPI assigned
- Jan 31, 2024
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 8
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2023
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Team Rehabilitation Services LLC
Practice addresses (Care Compare)
16000 Southfield Rd
Allen Park, MI 48101-2563
Phone (313) 359-8867
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TN, MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240731002256 | TN | Practitioner - Physical Therapist in Private Practice | 0749727410 | Reassigns benefits to 1 organization |
| I20241015000429 | MI | Practitioner - Physical Therapist in Private Practice | 0749727410 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT41293 | FL | MD | Physical Therapist |
| 5501303520 | MI | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Team Rehabilitation Services, LLC | Physical Therapist | Current |
Accepting new patients |
| Team Rehabilitation Services, LLC | Physical Therapist | Current |
Accepting new patients |
| Results-Ast JV, LLC | Physical Therapist | Current |
Accepting new patients |
| Douglass Orthopedic & Spine Rehabilitation, Inc. | Physical Therapist | Past |
Accepting new patients |
| Fyzbiz, LLC | Physical Therapist | Past |
Accepting new patients |
Locations
1200 Corporate Dr
Ste 400
Hoover, AL 35242
Phone (423) 238-7568
16000 Southfield Rd
Allen Park, MI 48101
Phone (313) 359-8867
485 Columbia Ave E
Ste 10
Battle Creek, MI 49014
Phone (269) 719-8110
33900 Harper Ave
Ste 104
Clinton Twp, MI 48035
Phone (586) 416-9100
921 Gallatin Ave
Ste 102
Nashville, TN 37206
Phone (629) 777-1520
2030 Cowan Hwy
Ste 1
Winchester, TN 37398
Phone (931) 968-1080
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT41293 | FL | |
| Physical Therapist | 225100000X | 5501303520 | MI | Yes |
Addresses
Primary practice location
16000 Southfield Rd
Allen Park, MI 48101-2563
Mailing address
33900 Harper Ave Ste 104
Clinton TWP, MI 48035-4258
Other providers in Allen Park, MI
- Laura Brickey
- Bridge & Bloom Therapy PLLC
- Janessa Bringe
- Elizabeth Ashley Brown
- Susan Cabadas
- David Cannon
- Lacy Lakay Canzoneri
- Caregivers Plus LLC
- Gelmar Nathanael Carela
- Caremed Pharmacy LLC
All providers in Allen Park, MI · Physical Therapist in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 2, 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.