Active NPI
Matthew Ryan Nickerson, P.T. DPT
- Physical Therapist
- Chandler, AZ
National Provider Identifier
1164827044
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 10936
- Practice address
- 725 S. Dobson Rd
Suite 203
Chandler, AZ 85224-5679 - Phone
- (480) 807-6500
- Fax
- (480) 897-2700
- NPI assigned
- Nov 4, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 10936 | AZ | Primary |
Addresses
Primary practice location
725 S. Dobson Rd
Suite 203
Chandler, AZ 85224-5679
Mailing address
4858 E Baseline Rd
Suite 107
Mesa, AZ 85206-4638
Phone (480) 807-6500
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10936 | AZ | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1415059200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1415059200000",
"number": "1164827044",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4858 E BASELINE RD",
"address_2": "SUITE 107",
"city": "MESA",
"state": "AZ",
"postal_code": "852064638",
"telephone_number": "480-807-6500",
"fax_number": "480-897-2700"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "725 S. DOBSON RD",
"address_2": "SUITE 203",
"city": "CHANDLER",
"state": "AZ",
"postal_code": "852245679",
"telephone_number": "480-807-6500",
"fax_number": "480-897-2700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICKERSON",
"first_name": "MATTHEW",
"middle_name": "RYAN",
"name_prefix": "Mr.",
"credential": "P.T. DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-11-04",
"last_updated": "2014-11-04",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "AZ",
"license": "10936",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chandler, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.