Nicole Diane Van Pelt, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT22780 Issued in FL

Practice address

807 N Tyndall Pkwy
Panama City, FL 32404-9495

Phone

(850) 763-0505

Fax

(850) 763-0966

NPI assigned

Mar 24, 2009

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

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Paragon Outpatient Rehabilitation Services LLCGroup PAC ID 8022272848, 199 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.

• Paragon Outpatient Rehabilitation Services, LLC

  • Rehabilitation Clinic/Center
  • Louisville, KY
  • NPI 1871867325

  Physical Therapist, SC

  Medicare reassignment Care Compare group NPD
• Paragon Outpatient Rehabilitation Services, LLC

  • Rehabilitation Clinic/Center
  • Roxboro, NC
  • NPI 1245014380
  NPD

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

{
    "created_epoch": "1237852800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1237852800000",
    "number": "1760623698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "807 N TYNDALL PKWY",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324049495",
            "telephone_number": "850-763-0505",
            "fax_number": "850-763-0966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "807 N TYNDALL PKWY",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324049495",
            "telephone_number": "850-763-0505",
            "fax_number": "850-763-0966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN PELT",
        "first_name": "NICOLE",
        "middle_name": "DIANE",
        "name_prefix": "Mrs.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-03-24",
        "last_updated": "2009-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT22780",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Layra C Valdes Ramirez, DMD
• Benicia Valentine, RBT
• Michael Valerio, DPT
• Jennifer Valle
• Jennifer Van Berkum, LCSW
• Caryl Ann Vandeboe, CCC-A
• Lori Vanderhoof, CPO, LPO
• Tracy Lynee Vanderschaaf, R, M, MR
• Suellyn Vanderslice, PHD
• Kelly Vanhuisen, LMHC

• Physical Therapist in Panama City, FL
• Providers in Panama City, FL by specialty
• Physical Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2009; 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.