Active NPI
Nicole Basham, DPT
- Physical Therapist
- Stockton, CA
National Provider Identifier
1245661164
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 41238
- Practice address
- 10200 Trinity Pkwy Ste 205
Stockton, CA 95219-7288 - Phone
- (209) 451-3920
- Fax
- (209) 451-3902
- NPI assigned
- Dec 3, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT60408454 | WA | |
| Physical Therapist | 225100000X | 41238 | CA | Primary |
Addresses
Primary practice location
10200 Trinity Pkwy Ste 205
Stockton, CA 95219-7288
Mailing address
8557 Diamond Oak Way
Elk Grove, CA 95624-1749
Phone (858) 735-1753
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 |
|---|---|---|---|
| 41238 | CA | MD | Physical Therapist |
| PT60408454 | WA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1386028800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1245661164",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8557 DIAMOND OAK WAY",
"city": "ELK GROVE",
"state": "CA",
"postal_code": "956241749",
"telephone_number": "858-735-1753"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10200 TRINITY PKWY STE 205",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952197288",
"telephone_number": "209-451-3920",
"fax_number": "209-451-3902"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BASHAM",
"first_name": "NICOLE",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-12-03",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WA",
"license": "PT60408454",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "41238",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stockton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.