Active NPI
Nicole Roberts
- Physical Therapist
- Fort Wayne, IN
National Provider Identifier
1790469641
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 05015091A
- Practice address
- 3320 N Clinton St
Fort Wayne, IN 46805-1918 - Phone
- (260) 483-2100
- NPI assigned
- Jun 12, 2023
- 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 Therapist | 225100000X | 05015091A | IN | Primary |
Addresses
Primary practice location
3320 N Clinton St
Fort Wayne, IN 46805-1918
Mailing address
7924 Wildberry LN
Fort Wayne, IN 46815-8083
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Turnstone Center for Children and Adults With Disabilities, Inc. | Physical Therapist | Current | Accepting new patients |
Locations
3320 N Clinton St
Fort Wayne, IN 46805
Phone (260) 483-2100
Organizations & group practices 1
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.
-
- Physical Therapist
- Fort Wayne, IN
- NPI 1437158722
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1686528000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1726099200000",
"number": "1790469641",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7924 WILDBERRY LN",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468158083"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3320 N CLINTON ST",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468051918",
"telephone_number": "260-483-2100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTS",
"first_name": "NICOLE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-06-12",
"last_updated": "2024-09-12",
"certification_date": "2024-09-12",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IN",
"license": "05015091A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Wayne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.