Active NPI
Nicole Dacquisto, PT
- Sports Physical Therapist
- Atherton, CA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Physical Therapist
- License
- PT28642
- Practice address
- 3351 El Camino Real
Suite 180
Atherton, CA 94027-3811 - Phone
- (650) 365-8350
- Fax
- (650) 368-8353
- NPI assigned
- Mar 29, 2007
- 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 |
|---|---|---|---|---|
| Sports Physical Therapist | 2251S0007X | PT28642 | CA | Primary |
Addresses
Primary practice location
3351 El Camino Real
Suite 180
Atherton, CA 94027-3811
Mailing address
3351 El Camino Real
Suite 180
Atherton, CA 94027-3811
Phone (650) 365-8350
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PT28642 | Other | CA | PT LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2003
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
315 Diablo Rd
Danville, CA 94526-3409
Phone (925) 855-8343
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT28642 | CA | MD | Sports Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Barman & Sargent Inc | Current | Accepting new patients | |
| Barman & Sargent Inc | Sports | Current | Accepting new patients |
Locations
3351 El Camino Real
Ste 180
Atherton, CA 94027
Phone (650) 365-8350
315 Diablo Rd
Ste 110
Danville, CA 94526
Phone (925) 855-8343
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.
-
dba Diablo West Sports Medicine
- Sports Physical Therapist
- Menlo Park, CA
- NPI 1225156524
-
dba Diablo Physical Therapy and Sports Medicine
- Physical Therapist
- Danville, CA
- NPI 1396759171
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175126400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1639299365",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3351 EL CAMINO REAL",
"address_2": "SUITE 180",
"city": "ATHERTON",
"state": "CA",
"postal_code": "940273811",
"telephone_number": "650-365-8350",
"fax_number": "650-368-8353"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3351 EL CAMINO REAL",
"address_2": "SUITE 180",
"city": "ATHERTON",
"state": "CA",
"postal_code": "940273811",
"telephone_number": "650-365-8350",
"fax_number": "650-368-8353"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DACQUISTO",
"first_name": "NICOLE",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2251S0007X",
"taxonomy_group": "",
"desc": "Physical Therapist, Sports",
"state": "CA",
"license": "PT28642",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PT LICENSE",
"identifier": "PT28642",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Atherton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.