Active NPI
Elise Nickel
- Physical Therapy Assistant
- Wauwatosa, WI
National Provider Identifier
1376154575
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 3040-19
- Practice address
- 2999 N Mayfair Rd
Wauwatosa, WI 53222-4306 - Phone
- (414) 479-3737
- NPI assigned
- Aug 11, 2020
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 3040-19 | WI | Primary |
Addresses
Primary practice location
2999 N Mayfair Rd
Wauwatosa, WI 53222-4306
Mailing address
2999 N Mayfair Rd
Wauwatosa, WI 53222-4306
Phone (414) 479-3737
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | elise.nickel@aah.org |
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 |
|---|---|---|---|
| 3040-19 | WI | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1597104000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1597104000000",
"number": "1376154575",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2999 N MAYFAIR RD",
"city": "WAUWATOSA",
"state": "WI",
"postal_code": "532224306",
"telephone_number": "414-479-3737"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2999 N MAYFAIR RD",
"city": "WAUWATOSA",
"state": "WI",
"postal_code": "532224306",
"telephone_number": "414-479-3737"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICKEL",
"first_name": "ELISE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-08-11",
"last_updated": "2020-08-11",
"certification_date": "2020-08-11",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "WI",
"license": "3040-19",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "elise.nickel@aah.org",
"affiliation": "N",
"address_1": "2999 N Mayfair Rd",
"city": "Wauwatosa",
"state": "WI",
"country_code": "US",
"postal_code": "532224306",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Wauwatosa, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.