Active NPI
Nicklaus Ellif Biederwolf, PT, DPT, CSCS
- Orthopedic Physical Therapist
- Phoenix, AZ
National Provider Identifier
1497820476
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopedic Physical Therapist
- License
- 6704
- Practice address
- 11209 N Tatum Blvd
B-120
Phoenix, AZ 85028-3091 - Phone
- (602) 795-8441
- Fax
- (602) 795-8447
- NPI assigned
- Nov 22, 2006
- Last updated
- Nov 4, 2015
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Orthopedic Physical Therapist | 2251X0800X | 6704 | AZ | Primary |
Addresses
Primary practice location
11209 N Tatum Blvd
B-120
Phoenix, AZ 85028-3091
Mailing address
PO Box 269084
Oklahoma City, OK 73126-9084
Phone (623) 398-8072
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 908347 | Medicaid | AZ |
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Outcomes Wound Therapy PLLC | Past | Accepting new patients | |
| Miller Physical Therapy Inc | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Physical Therapist
- Scottsdale, AZ
- NPI 1275603714
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164153600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1446595200000",
"number": "1497820476",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 269084",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731269084",
"telephone_number": "623-398-8072",
"fax_number": "623-398-8235"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11209 N TATUM BLVD",
"address_2": "B-120",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850283091",
"telephone_number": "602-795-8441",
"fax_number": "602-795-8447"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BIEDERWOLF",
"first_name": "NICKLAUS",
"middle_name": "ELLIF",
"name_prefix": "Mr.",
"credential": "PT, DPT, CSCS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-22",
"last_updated": "2015-11-04",
"status": "A"
},
"taxonomies": [
{
"code": "2251X0800X",
"taxonomy_group": "",
"desc": "Physical Therapist, Orthopedic",
"state": "AZ",
"license": "6704",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "908347",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.