Individual provider Active NPI

Nadya Yasmina Nicholas, DPT

  • Physical Therapist
  • El Segundo, CA
National Provider Identifier
1497063846
Registry record updated Jan 16, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
36910 Issued in CA
Practice address
615 N Nash St Ste 306
El Segundo, CA 90245-2850
Phone
(310) 535-0008
NPI assigned
Sep 20, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 36910 CA Primary

Addresses

Primary practice location

615 N Nash St Ste 306
El Segundo, CA 90245-2850

Mailing address

615 N Nash St Ste 306
El Segundo, CA 90245-2850
Phone (310) 535-0008

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

LicenseStateTypeSpecialty
36910CAMDPeriodontist

Practice roles

OrganizationSpecialtyStatusNew patients
Made to Move Physical Therapy, Inc. Physical Therapist CurrentSince Jan 8, 2013 Accepting new patients
Physical Therapy Specialists Inc Physical Therapist PastSince Apr 15, 2000 Accepting new patients
W. Seth Bolling, MD, Inc Past Accepting new patients

Locations

615 N Nash St
Ste 306
El Segundo, CA 90245
Phone (310) 535-0008

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1284940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1358294400000",
    "number": "1497063846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 N NASH ST STE 306",
            "city": "EL SEGUNDO",
            "state": "CA",
            "postal_code": "902452850",
            "telephone_number": "310-535-0008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 N NASH ST STE 306",
            "city": "EL SEGUNDO",
            "state": "CA",
            "postal_code": "902452850",
            "telephone_number": "310-535-0008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLAS",
        "first_name": "NADYA",
        "middle_name": "YASMINA",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-09-20",
        "last_updated": "2013-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "36910",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in El Segundo, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2013; 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.