Nicole Domaschuk-Jackson, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

115416 Issued in AK

Practice address

1001 S Knik Goose Bay Rd
Wasilla, AK 99654-8083

Phone

(907) 729-3300

NPI assigned

Mar 2, 2012

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

• Nicole Domaschuk Former name

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southcentral Foundation 168 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Southcentral Foundation

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • McGrath, AK
  • NPI 1780614263

  TX

  Medicare reassignment Care Compare group NPD
• Southcentral Foundation

  • Multi-Specialty Clinic/Center
  • Wasilla, AK
  • NPI 1457196685
  NPD
• Southcentral Foundation

  • Community/Behavioral Health Agency
  • Sutton, AK
  • NPI 1588255970
  NPD

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

{
    "created_epoch": "1330646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762905600000",
    "number": "1346514718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7033 E TUDOR RD",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995071262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 S KNIK GOOSE BAY RD",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996548083",
            "telephone_number": "907-729-3300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMASCHUK-JACKSON",
        "first_name": "NICOLE",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-03-02",
        "last_updated": "2025-11-12",
        "certification_date": "2025-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AK",
            "license": "115416",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "DOMASCHUK",
            "credential": "PT, DPT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Melissa Dobbs
• Brown Hal Docherty
• Jessica Docherty, CARE COORDINATOR
• Elishaba Doerksen
• Megan Dollarhide
• Mary Katherine a Dombroski, BA
• Cathy Marie Donahoo
• Donald R McLean
• Donat Doni, PHARMD
• Tina Dorsey

• All providers in Wasilla, AK
• Physical Therapist in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2025; 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.