Active NPI
Corey Phillips Nickerson
- Physical Therapist
- San Antonio, TX
National Provider Identifier
1508419219
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1322584
- Practice address
- 1100 Wilford Hall Loop, Jbsa Lackland Afb
San Antonio, TX 78236 - Phone
- (210) 292-5034
- NPI assigned
- Jul 22, 2019
- 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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 1322584 | TX | Primary |
Addresses
Primary practice location
1100 Wilford Hall Loop, Jbsa Lackland Afb
San Antonio, TX 78236
Mailing address
1100 Wilford Hall Loop, Jbsa Lackland Afb
San Antonio, TX 78236
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 |
|---|---|---|---|
| 1322584 | TX | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1563753600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1782691200000",
"number": "1508419219",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1100 WILFORD HALL LOOP, JBSA LACKLAND AFB",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "78236"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1100 WILFORD HALL LOOP, JBSA LACKLAND AFB",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "78236",
"telephone_number": "210-292-5034"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICKERSON",
"first_name": "COREY",
"middle_name": "PHILLIPS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-07-22",
"last_updated": "2026-06-29",
"certification_date": "2026-06-29",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "TX",
"license": "1322584",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Antonio, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.