Self

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

006497 Issued in KY

Legal business name

SELF

Practice address

410 Jason Dr
Richmond, KY 40475-2291

Phone

(270) 775-2790

NPI assigned

Nov 7, 2014

Organization subpart

No

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

Authorized official

Name

Ms. Jessica Renee Bickwermert, DPT

Title

Physical Therapist

Phone

(270) 775-2790

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1415318400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1415318400000",
    "number": "1215333901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 JASON DR",
            "city": "RICHMOND",
            "state": "KY",
            "postal_code": "404752291",
            "telephone_number": "270-775-2790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 JASON DR",
            "city": "RICHMOND",
            "state": "KY",
            "postal_code": "404752291",
            "telephone_number": "270-775-2790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SELF",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-07",
        "last_updated": "2014-11-07",
        "status": "A",
        "authorized_official_last_name": "BICKWERMERT",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "270-775-2790",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "KY",
            "license": "006497",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Richmond, KY
• Providers in Richmond, KY by specialty
• Physical Therapist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 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.

Verify at the official NPI Registry.