Nicole L Oberholtzer, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

5501017877 Issued in MI

Practice address

5570 Wilson Ave SW Ste a
Wyoming, MI 49418-8867

Phone

(616) 855-1495

NPI assigned

Aug 30, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Nicole L Elders Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MI, CA2 enrollments

Enrollment records 2

Specialty

Physical Therapist in Private Practice

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Presidio Sport and Medicine, Inc.Group PAC ID 2466447651, 18 clinicians

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 and National Provider Directory roles.

• Presidio Sport & Medicine, Inc.

  • Physical Therapist
  • San Francisco, CA
  • NPI 1578565149
  Medicare reassignment Care Compare group NPD
• Hulst Jepsen Physical Therapy Inc

  • Physical Therapist
  • Grand Rapids, MI
  • NPI 1609957760
  Medicare reassignment NPD

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

{
    "created_epoch": "1472515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668384000000",
    "number": "1639625601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1162B GORGAS AVE",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941291406",
            "telephone_number": "415-561-6655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5570 WILSON AVE SW STE A",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "494188867",
            "telephone_number": "616-855-1495"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OBERHOLTZER",
        "first_name": "NICOLE",
        "middle_name": "L",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-30",
        "last_updated": "2022-11-14",
        "certification_date": "2022-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501017877",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "www.presidiosport.com",
            "affiliation": "Y",
            "endpointDescription": "website",
            "affiliationName": "Presidio Sport & Medicine, Inc.",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "email",
            "address_1": "1162B Gorgas Ave",
            "city": "San Francisco",
            "state": "CA",
            "country_code": "US",
            "postal_code": "941291406",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "ELDERS",
            "middle_name": "L",
            "credential": "PT, DPT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jerry V O'Brien, DO
• James O'Grady, DPT
• Margaret Maureen O'Hara, NP
• Emiley Nichole O'Pry, DO
• Obedi Family Afc LLC
• Samantha Obetts
• Arianna Ochsenrider
• Anya Odabasic, DO
• Joan Ogemaw, FSBD, CBD
• Christopher Ogston

• Physical Therapist in Wyoming, MI
• Providers in Wyoming, MI by specialty
• Physical Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2022; 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.