Nicolas Pedraza, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

070-026846 Issued in IL

Practice address

3266 Sycamore Rd
Dekalb, IL 60115-9621

Phone

(815) 756-8524

Fax

(815) 756-1841

NPI assigned

Aug 10, 2022

Last updated

Aug 10, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Northern Rehabilitation and Sports Medicine Associates

  • Physical Therapist
  • Genoa, IL
  • NPI 1831368612
  NPD (past)

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

{
    "created_epoch": "1660089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660089600000",
    "number": "1346978244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3266 SYCAMORE RD",
            "city": "DEKALB",
            "state": "IL",
            "postal_code": "601159621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3266 SYCAMORE RD",
            "city": "DEKALB",
            "state": "IL",
            "postal_code": "601159621",
            "telephone_number": "815-756-8524",
            "fax_number": "815-756-1841"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEDRAZA",
        "first_name": "NICOLAS",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-08-10",
        "last_updated": "2022-08-10",
        "certification_date": "2022-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070-026846",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "npedrazapt@northernrehabpt.com",
            "affiliation": "N",
            "address_1": "3266 Sycamore Rd",
            "city": "Dekalb",
            "state": "IL",
            "country_code": "US",
            "postal_code": "601159621",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Christa Patridge
• Talisa Marie Paul, MSW, CADC
• Theodore F Paul, D.C.
• Barbara L Paulson
• Melissa S Payne Wagner, PT
• Christine Marie Pelikan
• Frederick D Peltz, DDS
• Valerie Pena-Hernandez
• Barbara J Penkala, PHARMD
• Joseph Perkins

• Physical Therapist in Dekalb, IL
• Providers in Dekalb, IL by specialty
• Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.