Nathaniel Adam Nickerson

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT614222222222220166 Issued in WA

Practice address

11919 W Sunset Hwy Ste a
Airway Heights, WA 99001-9466

Phone

(509) 356-5200

NPI assigned

Feb 14, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

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.

• Fox Rehab Indiana LLC

  • Physical Therapist
  • Cherry Hill, NJ
  • NPI 1043568942

  IN

  Medicare reassignment NPD
• Summit Rehab Valley Corporation

  • Physical Therapist
  • Spokane Valley, WA
  • NPI 1932243425
  NPD (past)

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

{
    "created_epoch": "1581638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686096000000",
    "number": "1083247340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "407 E 2ND AVE STE 100",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992021428",
            "telephone_number": "509-455-6002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11919 W SUNSET HWY STE A",
            "city": "AIRWAY HEIGHTS",
            "state": "WA",
            "postal_code": "990019466",
            "telephone_number": "509-356-5200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICKERSON",
        "first_name": "NATHANIEL",
        "middle_name": "ADAM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-02-14",
        "last_updated": "2023-06-07",
        "certification_date": "2023-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT614222222222220166",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert A Miller, CDP
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• Douglas James Nelson
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• Jan Oliver
• Ashley M Olson, LMT
• Nicole Pedroso, LPN
• Brenda Peone, SUDP-T

• Physical Therapist in Airway Heights, WA
• Providers in Airway Heights, WA by specialty
• Physical Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.