Jacqueline Nicholson, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

Practice address

1130 Collins Rd
Jefferson, WI 53549-2939

Phone

(262) 470-6950

Fax

(262) 470-6950

NPI assigned

Nov 6, 2017

Sex

Female

Sole proprietor

No

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 WI

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Aegis Group Practice LLCGroup PAC ID 5193036432, 399 clinicians

Fox Rehabilitation Services Wi LLCGroup PAC ID 1658647581, 144 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Aegis Group Practice LLC

  • Physical Therapist
  • Onalaska, WI
  • NPI 1306336565
  Medicare reassignment Care Compare group NPD
• Fox Rehabilitation Services Wi LLC

  • Physical Therapist
  • Milwaukee, WI
  • NPI 1518483973
  Medicare reassignment Care Compare group NPD
• Aegis Group Practice LLC

  • Physical Therapist
  • Kimberly, WI
  • NPI 1710445580
  NPD
• Aegis Group Practice LLC

  • Physical Therapist
  • Indian Harbour Beach, FL
  • NPI 1932072030
  NPD
• Aegis Group Practice LLC

  • Physical Therapist
  • Indianapolis, IN
  • NPI 1083227169
  NPD (past)

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

{
    "created_epoch": "1509926400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1509926400000",
    "number": "1114430725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "412 E FOREST ST",
            "city": "OCONOMOWOC",
            "state": "WI",
            "postal_code": "530663708",
            "telephone_number": "262-470-6950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1130 COLLINS RD",
            "city": "JEFFERSON",
            "state": "WI",
            "postal_code": "535492939",
            "telephone_number": "262-470-6950",
            "fax_number": "262-470-6950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLSON",
        "first_name": "JACQUELINE",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-11-06",
        "last_updated": "2017-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ronalee Ann Monroe, RN
• Christine Mary Moreira, R.N.
• Mueller Drugs, Inc.
• Alexander Nenov, PHARM.D
• Pamela Jean Newcomb
• Robert William Niebler, RPH
• Kelly Ann North, LCSW
• Heather L O'Neill, M.S., CCC-SLP
• Sarah Oberholtzer, AGPCNP-BC
• Laura Ott

• Physical Therapist in Jefferson, WI
• Providers in Jefferson, WI by specialty
• Physical Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2017; 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.