Nicole Marie Redwine, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA1936 Issued in NM

Practice address

4617 Bismark Hills Way NE
Rio Rancho, NM 87144-8608

Phone

(505) 315-9649

NPI assigned

Apr 15, 2022

Last updated

Apr 15, 2022By 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 1

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": "1649980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649980800000",
    "number": "1790428928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4617 BISMARK HILLS WAY NE",
            "city": "RIO RANCHO",
            "state": "NM",
            "postal_code": "871448608",
            "telephone_number": "505-315-9649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4617 BISMARK HILLS WAY NE",
            "city": "RIO RANCHO",
            "state": "NM",
            "postal_code": "871448608",
            "telephone_number": "505-315-9649"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REDWINE",
        "first_name": "NICOLE",
        "middle_name": "MARIE",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-15",
        "last_updated": "2022-04-15",
        "certification_date": "2022-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "NM",
            "license": "PTA1936",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapy Assistant in Rio Rancho, NM
• Providers in Rio Rancho, 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 Apr 15, 2022; 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.