Active NPI
Nicole Carvacho, PT, MS
- Pediatric Physical Therapist
- Addison, TX
National Provider Identifier
1568875318
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Physical Therapist
- License
- 1211128
- Practice address
- 17480 North Dallas Tollway
Addison, TX 75287 - Phone
- (214) 623-5900
- Fax
- (214) 623-5901
- NPI assigned
- Jun 10, 2014
- Last updated
- Jun 10, 2014
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Pediatric Physical Therapist | 2251P0200X | 1211128 | TX | Primary |
Addresses
Primary practice location
17480 North Dallas Tollway
Addison, TX 75287
Mailing address
305 NE Loop 280
Business Tower 1 Suite 200
Hurst, TX 76053
Phone (817) 292-8787
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)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1211128 | TX | MD | Pediatric Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1402358400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1402358400000",
"number": "1568875318",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "305 NE LOOP 280",
"address_2": "BUSINESS TOWER 1 SUITE 200",
"city": "HURST",
"state": "TX",
"postal_code": "76053",
"telephone_number": "817-292-8787",
"fax_number": "817-789-6849"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17480 NORTH DALLAS TOLLWAY",
"city": "ADDISON",
"state": "TX",
"postal_code": "75287",
"telephone_number": "214-623-5900",
"fax_number": "214-623-5901"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARVACHO",
"first_name": "NICOLE",
"name_prefix": "Mrs.",
"credential": "PT, MS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-06-10",
"last_updated": "2014-06-10",
"status": "A"
},
"taxonomies": [
{
"code": "2251P0200X",
"taxonomy_group": "",
"desc": "Physical Therapist, Pediatrics",
"state": "TX",
"license": "1211128",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Addison, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.