Nicole Cathleen Fernandez, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

60785817 Issued in WA

Practice address

111 Tumwater Blvd SE Ste 113
Tumwater, WA 98501-6422

Phone

(360) 528-3300

Fax

(360) 528-8162

NPI assigned

Nov 7, 2017

Last updated

May 7, 2025By 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

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pro-Active Sportsmed PLLCGroup PAC ID 2062303969, 6 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Pro-Active Sportsmed PLLC

  • Orthopedic Physical Therapist
  • Tumwater, WA
  • NPI 1861612335
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1510012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746576000000",
    "number": "1679086144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 TUMWATER BLVD SE STE 113",
            "city": "TUMWATER",
            "state": "WA",
            "postal_code": "985016422",
            "telephone_number": "360-528-3300",
            "fax_number": "360-528-8162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 TUMWATER BLVD SE STE 113",
            "city": "TUMWATER",
            "state": "WA",
            "postal_code": "985016422",
            "telephone_number": "360-528-3300",
            "fax_number": "360-528-8162"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FERNANDEZ",
        "first_name": "NICOLE",
        "middle_name": "CATHLEEN",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-11-07",
        "last_updated": "2025-05-07",
        "certification_date": "2025-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "60785817",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fasa Family Wellness, PLLC
• Lisa Feeley
• Katherine Harter Fehsenfeld, PA-C,MAC,LAC
• Mark T Felton, LMHC
• Renee Fermin
• Tamara S Fiedler
• Harley Fields, ATC/L, PTA
• Jonathan M Fink, L.M.P.
• Megan E Fitzgerald, A.T.C.
• Rose Kristin Flickinger, AAC 61405052

• Physical Therapist in Tumwater, WA
• Providers in Tumwater, WA by specialty
• Physical Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2025; 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.