Individual provider Active NPI

Nicole Nokleby, DPT

  • Physical Therapist
  • Salt Lake City, UT
National Provider Identifier
1528424447
Registry record updated Jan 7, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
9431602-2401 Issued in UT
Practice address
4209 S Jupiter Dr
Salt Lake City, UT 84124-3374
Phone
(801) 921-3725
NPI assigned
Jan 7, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 7, 2016

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 9431602-2401 UT Primary

Addresses

Primary practice location

4209 S Jupiter Dr
Salt Lake City, UT 84124-3374

Mailing address

4209 S Jupiter Dr
Salt Lake City, UT 84124-3374
Phone (801) 921-3725

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230816003044 UT Practitioner - Physical Therapist in Private Practice 1658733019 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ihc Health Services IncGroup PAC ID 1850209420, 3,948 clinicians

Practice addresses (Care Compare)

12473 S Minuteman Dr
Draper, UT 84020-7870
Phone (801) 495-7950

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Ihc Health Services Inc Physical Therapist CurrentSince Jun 24, 2023 Accepting new patients
Ihc Health Services, Inc. CurrentSince Jun 24, 2023 Accepting new patients

Locations

12473 S Minuteman Dr
Draper, UT 84020
Phone (801) 495-7900

5171 S Cottonwood St
Ste 900
Salt Lake City, UT 84107
Phone (801) 507-2050

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1452124800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1452124800000",
    "number": "1528424447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4209 S JUPITER DR",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841243374",
            "telephone_number": "801-921-3725"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4209 S JUPITER DR",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841243374",
            "telephone_number": "801-921-3725"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NOKLEBY",
        "first_name": "NICOLE",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-01-07",
        "last_updated": "2016-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "UT",
            "license": "9431602-2401",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.