Jennifer S Nicewanner, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

072167 Issued in IA

Practice address

250 12TH Ave
Suite 160
Coralville, IA 52241-2911

Phone

(319) 354-4800

Fax

(319) 354-4819

NPI assigned

Jun 25, 2006

Last updated

Jun 18, 2014By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• SSM Select Rehab St. Louis, LLC

  dba SSM Physical Therapy

  • Rehabilitation Practitioner
  • Breese, IL
  • NPI 1740166347
  NPD (past)

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

{
    "created_epoch": "1151193600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1403049600000",
    "number": "1659307031",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 12TH AVE",
            "address_2": "SUITE 160",
            "city": "CORALVILLE",
            "state": "IA",
            "postal_code": "522412911",
            "telephone_number": "319-354-4800",
            "fax_number": "319-354-4819"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 12TH AVE",
            "address_2": "SUITE 160",
            "city": "CORALVILLE",
            "state": "IA",
            "postal_code": "522412911",
            "telephone_number": "319-354-4800",
            "fax_number": "319-354-4819"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICEWANNER",
        "first_name": "JENNIFER",
        "middle_name": "S",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-25",
        "last_updated": "2014-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IA",
            "license": "072167",
            "primary": true
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "MO",
            "license": "PT110022",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tracie Lea Neustel, ARNP
• Christina P Neve, PHARMD
• New Leaf Counseling, PLLC
• Next Gen Family Dental Practice (The Family Dental Center)
• Abdias Jeufack Nguegang
• Cindy Nichols Nichols Anderson, PH.D., ABPP
• Charlene Nightingale
• Upneet Kaur Nijjar, MD
• Raven N Niles, ARNP
• Kelly Nissen, LISW

• Physical Therapist in Coralville, IA
• Providers in Coralville, IA by specialty
• Physical Therapist in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 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.

Verify at the official NPI Registry.