Keegan Nichols, MS, ATC, SPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

7532 Issued in ID

Practice address

554 N Steelhead Way Ste 162
Boise, ID 83704-8388

Phone

(208) 323-9747

Fax

(208) 323-9752

NPI assigned

Sep 29, 2015

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 ID

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Wright Physical Therapy Limited PartnershipGroup PAC ID 1759612641, 52 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

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.

• Wright Physical Therapy Limited Partnership

  • Physical Therapist
  • Twin Falls, ID
  • NPI 1730732025
  Medicare reassignment Care Compare group NPD
• Wright Physical Therapy Limited Partnership

  • Physical Therapist
  • Logan, UT
  • NPI 1770317455
  NPD

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

{
    "created_epoch": "1443484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629158400000",
    "number": "1265802631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 S LOCUST GROVE RD UNIT O101",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836426389",
            "telephone_number": "618-789-5704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "554 N STEELHEAD WAY STE 162",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837048388",
            "telephone_number": "208-323-9747",
            "fax_number": "208-323-9752"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLS",
        "first_name": "KEEGAN",
        "name_prefix": "Mr.",
        "credential": "MS, ATC, SPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-09-29",
        "last_updated": "2021-08-17",
        "certification_date": "2021-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "ID",
            "license": "7532",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deanna Boyadjyan Nibbs
• Valerie Nicasio, RN
• Emily Nicholas, LCSW
• David Nichols, M.COUN., LPC, NCC
• Heather E Nichols, M.D.
• Molly Nichols
• Roxanne Marie Nichols, NP
• Tanya Nichols
• Charles Richard Nicholson, O.D.
• Keaton Nicholson

• Physical Therapist in Boise, ID
• Providers in Boise, ID by specialty
• Physical Therapist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2021; 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.