Active NPI
Jon O Nickey, P.T.
- Physical Therapist
- Perrysburg, OH
National Provider Identifier
1295912939
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT.012004
- Practice address
- 12611 Eckel Junction Rd
Perrysburg, OH 43551-1304 - Phone
- (877) 511-9739
- Fax
- (419) 745-8819
- NPI assigned
- Jan 24, 2008
- Sex
- Male
- 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 Therapist | 225100000X | PT.012004 | OH | Primary |
Addresses
Primary practice location
12611 Eckel Junction Rd
Perrysburg, OH 43551-1304
Mailing address
12611 Eckel Junction Rd
Perrysburg, OH 43551-1304
Phone (877) 511-9739
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2904816 | Medicaid | OH |
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 |
|---|---|---|---|
| PT.012004 | OH | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1201132800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1321401600000",
"number": "1295912939",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12611 ECKEL JUNCTION RD",
"city": "PERRYSBURG",
"state": "OH",
"postal_code": "435511304",
"telephone_number": "877-511-9739",
"fax_number": "419-745-8819"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12611 ECKEL JUNCTION RD",
"city": "PERRYSBURG",
"state": "OH",
"postal_code": "435511304",
"telephone_number": "877-511-9739",
"fax_number": "419-745-8819"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICKEY",
"first_name": "JON",
"middle_name": "O",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-01-24",
"last_updated": "2011-11-16",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "OH",
"license": "PT.012004",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2904816",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Perrysburg, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.