Nicole Selvaraj, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

17987 Issued in MA

Practice address

170 Governors Ave
Medford, MA 02155-1643

Phone

(781) 395-7750

NPI assigned

Jul 24, 2007

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 MA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2007

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Fox Rehab Ma LLC

  • Physical Therapist
  • Waltham, MA
  • NPI 1497174437
  Medicare reassignment NPD
• Multiple Sclerosis Specialty Center, LLC

  • Neurology Physical Therapist
  • Waltham, MA
  • NPI 1831594282
  Medicare reassignment NPD

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

{
    "created_epoch": "1185235200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696550400000",
    "number": "1245430487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 MAIN ST STE 105",
            "city": "MEDFORD",
            "state": "MA",
            "postal_code": "021554530",
            "telephone_number": "781-395-7750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "170 GOVERNORS AVE",
            "city": "MEDFORD",
            "state": "MA",
            "postal_code": "021551643",
            "telephone_number": "781-395-7750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SELVARAJ",
        "first_name": "NICOLE",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-24",
        "last_updated": "2023-10-06",
        "certification_date": "2023-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MA",
            "license": "17987",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marc Schwendemann, PSYD
• Carolyn Schwirz
• Nicole Lyn Scouras, FNP
• Sea Glass Clinical Services LLC
• Dan Seligman, D.P.M.
• Jovan Emmanuel Sematimba, RN
• Eva Ray Senner, LICSW
• Debra R. Severo, RNCS
• Shafa Physical Therapy
• Kipa Shakya, DMD

• Physical Therapist in Medford, MA
• Providers in Medford, MA by specialty
• Physical Therapist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2023; 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.