Charles Nichols III

Primary specialty

Geriatric Physical TherapistTaxonomy code 2251G0304X

License

60380553 Issued in WA

Practice address

119 W Columbia Ave
Spokane, WA 99205-6224

Phone

(509) 294-5579

NPI assigned

Apr 27, 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 WA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Northwest Mobile Physical Therapy Specialists PLLC

  • Physical Therapy Clinic/Center
  • Spokane, WA
  • NPI 1366063778
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1587945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588550400000",
    "number": "1194346502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 W COLUMBIA AVE",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992056224",
            "telephone_number": "509-294-5579"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 W COLUMBIA AVE",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992056224",
            "telephone_number": "509-294-5579"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLS",
        "first_name": "CHARLES",
        "name_suffix": "III",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-27",
        "last_updated": "2020-05-04",
        "certification_date": "2020-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "60360553",
            "primary": false
        },
        {
            "code": "2251G0304X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Geriatrics",
            "state": "WA",
            "license": "60380553",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicholas Soirez, LLC
• Doreen A Nicholas, CCC-SLP
• Samantha Nicholas
• Samantha Nicholas
• Allison Kendall Nichols, PA-C
• Claudia Nichols, RN60080458
• Frederick William Nichols Jr., PHARMD
• Jeana Nichols
• Joni C Nichols, M.D.
• Kelly Nichols

• Geriatric Physical Therapist in Spokane, WA
• Providers in Spokane, WA by specialty
• Geriatric Physical Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2020; 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.