Nickol Marie Cleary, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT013551L Issued in PA

Practice address

785 E Mountain Rd
Port Matilda, PA 16870

Phone

(814) 238-3485

NPI assigned

Oct 26, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Nickol Marie Nicka Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Vital Rehab and Wellness

  • Physical Therapy Clinic/Center
  • State College, PA
  • NPI 1598350340

  Physical Therapist

  NPD

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

{
    "created_epoch": "1445817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1447977600000",
    "number": "1326410622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1110 W SPRINGFIELD DR",
            "city": "BELLEFONTE",
            "state": "PA",
            "postal_code": "168236730",
            "telephone_number": "814-558-7625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "785 E MOUNTAIN RD",
            "city": "PORT MATILDA",
            "state": "PA",
            "postal_code": "16870",
            "telephone_number": "814-238-3485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLEARY",
        "first_name": "NICKOL",
        "middle_name": "MARIE",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-10-26",
        "last_updated": "2015-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "PA",
            "license": "PT013551L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICKOL",
            "last_name": "NICKA",
            "middle_name": "MARIE",
            "credential": "PT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Centrescope Diagnostics, LLC
• Kelly Ann Cessna, D.O.
• Grant Austin Ciavarella, D.O.
• Robert H Cinatl, DDS
• Anne Sommerfeld Clause, PA-C
• David A Coggins, M.D.
• Dana C Colonese, DPT
• Dana Conroy, FNP-C
• Todd B Cousins, DO
• Brandon Craft, M.D.

• Physical Therapist in Port Matilda, PA
• Providers in Port Matilda, PA by specialty
• Physical Therapist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.