Individual provider Active NPI

Nicholas Myers

  • Physical Therapist
  • Jacksonville, FL
National Provider Identifier
1093443392
Registry record updated Aug 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Practice address
3901 University Blvd S Ste 103
Jacksonville, FL 32216-4374
Phone
(904) 345-7373
NPI assigned
Aug 13, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X Primary

Addresses

Primary practice location

3901 University Blvd S Ste 103
Jacksonville, FL 32216-4374

Mailing address

2351 N Williamson Blvd Apt 13107
Daytona Beach, FL 32117-5912

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230816002810 FL Practitioner - Physical Therapist in Private Practice 6608238050 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Optimal Performance & Physical Therapies Tyrone, LLC Physical Therapist CurrentSince Jun 22, 2023 Accepting new patients
Optimal Performance and Physical Therapies St. Petersburg, LLC Physical Therapist CurrentSince Sep 4, 2024 Accepting new patients
Burke Collins Therapy, Inc Past Accepting new patients
H2 Rehabilitation Services of Florida LLC Past Accepting new patients
H2 Rehabilitation Services of Florida LLC Past Accepting new patients
H2 Rehabilitation Services of Florida LLC Past Accepting new patients

Locations

21756 State Road 54
Ste 102
Lutz, FL 33549
Phone (813) 279-6234

1700 66th St N
Ste 102
St Petersburg, FL 33710
Phone (727) 202-4627

2600 Dr Martin Luther King Jr St N
Ste 200B
St Petersburg, FL 33704
Phone (727) 202-4625

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1660348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660348800000",
    "number": "1093443392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2351 N WILLIAMSON BLVD APT 13107",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321175912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3901 UNIVERSITY BLVD S STE 103",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322164374",
            "telephone_number": "904-345-7373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MYERS",
        "first_name": "NICHOLAS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-08-13",
        "last_updated": "2022-08-13",
        "certification_date": "2022-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2022; 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.