Active NPI
Nicole L Oldfather, PTA
- Physical Therapy Assistant
- Kendallville, IN
National Provider Identifier
1770079147
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 06002493A
- Practice address
- 702 N Sawyer Rd
Kendallville, IN 46755-2532 - Phone
- (260) 347-3333
- NPI assigned
- Jul 9, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 06002493A | IN | Primary |
Addresses
Primary practice location
702 N Sawyer Rd
Kendallville, IN 46755-2532
Mailing address
965 W Ryan Rd
Columbia City, IN 46725-8402
Phone (260) 229-3089
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 06002493A | IN | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1531094400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1531094400000",
"number": "1770079147",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "965 W RYAN RD",
"city": "COLUMBIA CITY",
"state": "IN",
"postal_code": "467258402",
"telephone_number": "260-229-3089"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "702 N SAWYER RD",
"city": "KENDALLVILLE",
"state": "IN",
"postal_code": "467552532",
"telephone_number": "260-347-3333"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OLDFATHER",
"first_name": "NICOLE",
"middle_name": "L",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-07-09",
"last_updated": "2018-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "IN",
"license": "06002493A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kendallville, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.