Nicholas Penner

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA1599 Issued in NM

Practice address

1005 Lujan Hill Rd
Las Cruces, NM 88007-6304

Phone

(575) 523-4573

NPI assigned

Jan 13, 2023

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1673568000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675296000000",
    "number": "1699480673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5031 WESTFIELD DR NE",
            "city": "RIO RANCHO",
            "state": "NM",
            "postal_code": "871446564",
            "telephone_number": "661-547-6380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1005 LUJAN HILL RD",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880076304",
            "telephone_number": "575-523-4573"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENNER",
        "first_name": "NICHOLAS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-01-13",
        "last_updated": "2023-02-02",
        "certification_date": "2023-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapy Assistant",
            "state": "NM",
            "license": null,
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapy Assistant",
            "state": "NM",
            "license": "PTA1599",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gabriel Pena
• Jacob Pena
• Rachel Elizabeth Pena, LMSW
• Ruby Marie Pena
• Debbie Pendleton
• William D Penner, COTA/L
• Breck Penrod
• Delia Perales, CASE MANAGER
• Gamaliel Perales, MD
• Roxana Peralta

• Physical Therapy Assistant in Las Cruces, NM
• Providers in Las Cruces, NM by specialty
• Physical Therapy Assistant in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2023; 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.