Active NPI
Nicole Nichols, PT, DPT
- Physical Therapist
- East Jordan, MI
National Provider Identifier
1336301704
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT13066
- Practice address
- 4895 Lois LN
East Jordan, MI 49727-9430 - Phone
- (231) 818-0521
- NPI assigned
- Jun 27, 2008
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT13066 | NC | Primary |
| Physical Therapist | 225100000X | 5501012800 | MI |
Addresses
Primary practice location
4895 Lois LN
East Jordan, MI 49727-9430
Mailing address
1338 South Extension Road
Topinabee, MI 49791
Phone (231) 818-0521
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 |
|---|---|---|---|
| 5501012800 | MI | MD | Physical Therapist |
| PT13066 | NC | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1214524800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1733529600000",
"number": "1336301704",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1338 SOUTH EXTENSION ROAD",
"city": "TOPINABEE",
"state": "MI",
"postal_code": "49791",
"telephone_number": "231-818-0521"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4895 LOIS LN",
"city": "EAST JORDAN",
"state": "MI",
"postal_code": "497279430",
"telephone_number": "231-818-0521"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICHOLS",
"first_name": "NICOLE",
"credential": "PT, DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-06-27",
"last_updated": "2024-12-07",
"certification_date": "2024-12-07",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NC",
"license": "PT13066",
"primary": true
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MI",
"license": "5501012800",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in East Jordan, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.