Individual provider Active NPI

Diann Nichols, PTA

  • Physical Therapy Assistant
  • Anderson, IN
National Provider Identifier
1619306487
Registry record updated Nov 2, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
License
06004656A Issued in IN
Practice address
800 Main St
Ste 310
Anderson, IN 46016-1559
Phone
(765) 644-0500
Fax
(765) 644-0510
NPI assigned
Nov 2, 2013
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 2, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X 06004656A IN Primary

Addresses

Primary practice location

800 Main St
Ste 310
Anderson, IN 46016-1559

Mailing address

800 Main St
Ste 310
Anderson, IN 46016-1559
Phone (765) 644-0500

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

State licenses

LicenseStateTypeSpecialty
06004656AINMDPhysical Therapy Assistant

NPI Registry JSON

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

{
    "created_epoch": "1383350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1383350400000",
    "number": "1619306487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 MAIN ST",
            "address_2": "STE 310",
            "city": "ANDERSON",
            "state": "IN",
            "postal_code": "460161559",
            "telephone_number": "765-644-0500",
            "fax_number": "765-644-0510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 MAIN ST",
            "address_2": "STE 310",
            "city": "ANDERSON",
            "state": "IN",
            "postal_code": "460161559",
            "telephone_number": "765-644-0500",
            "fax_number": "765-644-0510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLS",
        "first_name": "DIANN",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-11-02",
        "last_updated": "2013-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "IN",
            "license": "06004656A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Anderson, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 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.