Nicole Derue, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

0281751 Issued in NY

Practice address

3165 East Ave
Central Square, NY 13036-2706

Phone

(315) 676-3826

Fax

(315) 676-3402

NPI assigned

Jan 2, 2007

Last updated

Mar 12, 2026By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Nicole Derue Physical Therapy P.C.

  dba Fairway Physical Therapy North

  • Physical Therapy Clinic/Center
  • Central Square, NY
  • NPI 1053503185
  Medicare reassignment NPD Authorized official
• Michael P McGee Physical Therapy PC

  • Physical Therapist
  • East Syracuse, NY
  • NPI 1205997822
  NPD (past)

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

{
    "created_epoch": "1167696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773273600000",
    "number": "1629135371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3165 EAST AVE",
            "city": "CENTRAL SQUARE",
            "state": "NY",
            "postal_code": "130362706",
            "telephone_number": "315-676-3826",
            "fax_number": "315-676-3402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3165 EAST AVE",
            "city": "CENTRAL SQUARE",
            "state": "NY",
            "postal_code": "130362706",
            "telephone_number": "315-676-3826",
            "fax_number": "315-676-3402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERUE",
        "first_name": "NICOLE",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-02",
        "last_updated": "2026-03-12",
        "certification_date": "2026-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "0281751",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "0281751",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Harald J Cohen, RPH
• Susan B Comstock, RN
• Susan Jane Coulter
• Constance M Dean Weimar, LPN
• Daniel Joseph Demauro, DDS
• Dignity Plus, Inc
• Dignity Plus, Inc
• Jennifer Homer Eckardt, MS PT
• Excel Physical Therapy
• Richard A Frio, OD

• Physical Therapist in Central Square, NY
• Providers in Central Square, NY by specialty
• Physical Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2026; 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.