Garrett Wayne Nicol, PT, DPT, ATC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

2018025002 Issued in MO

Practice address

7201 E 147TH St Ste 120
Grandview, MO 64030

Phone

(816) 425-3580

Fax

(816) 425-3641

NPI assigned

Jul 12, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1531353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575244800000",
    "number": "1477039402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 W DOUGLAS AVE STE 1040",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672023017",
            "telephone_number": "316-263-0003",
            "fax_number": "316-263-1241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7201 E 147TH ST STE 120",
            "city": "GRANDVIEW",
            "state": "MO",
            "postal_code": "64030",
            "telephone_number": "816-425-3580",
            "fax_number": "816-425-3641"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1321 SW Market St",
            "address_purpose": "LOCATION",
            "city": "Lees Summit",
            "state": "MO",
            "postal_code": "640812904",
            "country_code": "US",
            "telephone_number": "816-607-7180",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NICOL",
        "first_name": "GARRETT",
        "middle_name": "WAYNE",
        "credential": "PT, DPT, ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-07-12",
        "last_updated": "2019-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "KS",
            "license": "11-05883",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MO",
            "license": "2018025002",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Grandview, MO
• Physical Therapist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.