Active NPI
Elexa Nickerson
- Physical Therapy Assistant
- Orono, ME
National Provider Identifier
1285188052
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- PA4696
- Practice address
- 117 Bennoch Rd
Orono, ME 04473-3620 - Phone
- (207) 866-4914
- NPI assigned
- Aug 10, 2016
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | PA4696 | ME | Primary |
Addresses
Primary practice location
117 Bennoch Rd
Orono, ME 04473-3620
Mailing address
98 Poplar St
Old Town, ME 04468-5901
Phone (207) 745-4955
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA4696 | ME | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1470787200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1470787200000",
"number": "1285188052",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "98 POPLAR ST",
"city": "OLD TOWN",
"state": "ME",
"postal_code": "044685901",
"telephone_number": "207-745-4955"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "117 BENNOCH RD",
"city": "ORONO",
"state": "ME",
"postal_code": "044733620",
"telephone_number": "207-866-4914"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICKERSON",
"first_name": "ELEXA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-08-10",
"last_updated": "2016-08-10",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "ME",
"license": "PA4696",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Orono, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.