Active NPI
Teresa Moore Niccum, PT
- Physical Therapist
- Milwaukie, OR
National Provider Identifier
1427194182
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT17997
- Practice address
- 4560 SE International Way Suite 100
Consonus Healthcare Services
Milwaukie, OR 97222 - Phone
- (971) 206-5129
- Fax
- (971) 206-5209
- NPI assigned
- Jan 29, 2007
- 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 Therapist | 225100000X | PT17997 | CA | Primary |
Addresses
Primary practice location
4560 SE International Way Suite 100
Consonus Healthcare Services
Milwaukie, OR 97222
Mailing address
286 Ocean Ave
Monterey, CA 93940
Phone (831) 229-3022
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT17997 | CA | MD | Orthopedic Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Action Physical Therapy Partners, Inc | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Specialist
- Salinas, CA
- NPI 1578945044
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170028800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1427194182",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "286 OCEAN AVE",
"city": "MONTEREY",
"state": "CA",
"postal_code": "93940",
"telephone_number": "831-229-3022"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4560 SE INTERNATIONAL WAY SUITE 100",
"address_2": "CONSONUS HEALTHCARE SERVICES",
"city": "MILWAUKIE",
"state": "OR",
"postal_code": "97222",
"telephone_number": "971-206-5129",
"fax_number": "971-206-5209"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICCUM",
"first_name": "TERESA",
"middle_name": "MOORE",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "PT17997",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Milwaukie, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.