Individual provider Active NPI

Nicolle Ann Hendrick, DPT

  • Physical Therapist
  • Boardman, OH
National Provider Identifier
1255989836
Registry record updated Aug 28, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT012432 Issued in OH
Practice address
835 McKay CT Ste 100
Boardman, OH 44512-5786
Phone
(330) 965-3899
Fax
(330) 965-3839
NPI assigned
Aug 28, 2019
Last updated
Aug 28, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT012432 OH Primary

Addresses

Primary practice location

835 McKay CT Ste 100
Boardman, OH 44512-5786

Mailing address

835 McKay CT Ste 100
Boardman, OH 44512-5786
Phone (330) 965-3899

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191028002055 OH Practitioner - Physical Therapist in Private Practice 4981936077 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

835 McKay CT
Suite 100
Boardman, OH 44512-5786
Phone (330) 758-4399

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT012432OHMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Health Physicians Youngstown, LLC CurrentSince Oct 1, 2019 Accepting new patients
Mercy Health Physicians Youngstown Specialty Care LLC CurrentSince Jan 1, 2022 Accepting new patients
Mercy Health Physicians Youngstown Specialty Care LLC CurrentSince Jan 1, 2022 Accepting new patients
Mercy Health Physicians Youngstown LLC CurrentSince Oct 1, 2019 Accepting new patients

Locations

107 Royal Birkdale Dr
Ste A
Columbiana, OH 44408
Phone (330) 482-9350

410 W 10th Ave
Columbus, OH 43210
Phone (614) 293-5905

1044 Belmont Ave
Youngstown, OH 44504
Phone (330) 480-2182

250 E Federal St
Fl 4
Youngstown, OH 44503
Phone (330) 884-7010

835 McKay Ct
Ste 100
Youngstown, OH 44512
Phone (330) 758-4399

Interoperability endpoints

  • Direct secure messaging: nhendrick37174@direct.bsmhealth.org

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1566950400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566950400000",
    "number": "1255989836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "835 MCKAY CT STE 100",
            "city": "BOARDMAN",
            "state": "OH",
            "postal_code": "445125786",
            "telephone_number": "330-965-3899",
            "fax_number": "330-965-3839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "835 MCKAY CT STE 100",
            "city": "BOARDMAN",
            "state": "OH",
            "postal_code": "445125786",
            "telephone_number": "330-965-3899",
            "fax_number": "330-965-3839"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDRICK",
        "first_name": "NICOLLE",
        "middle_name": "ANN",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-28",
        "last_updated": "2019-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OH",
            "license": "PT012432",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boardman, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2019; 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.