Nicolette Theard, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT25569 Issued in CA

Practice address

900 Wilshire Blvd
Suite 315
Santa Monica, CA 90401-1872

Phone

(310) 458-0261

NPI assigned

Dec 18, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

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.

• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Santa Clara, CA
  • NPI 1073606299

  Single Specialty

  Medicare reassignment NPD
• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Stockton, CA
  • NPI 1548343510

  Single Specialty

  NPD
• Permanente Medical Group, Inc

  • Clinical Medical Laboratory
  • San Jose, CA
  • NPI 1497971584
  NPD
• Adi Rehab, Incorporated

  • Physical Therapist
  • Los Angeles, CA
  • NPI 1104850197

  Single Specialty

  NPD (past)
• Blake Physical Therapy, PC

  • Orthopedic Physical Therapist
  • Santa Monica, CA
  • NPI 1750350476

  Single Specialty

  NPD (past)

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

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644537600000",
    "number": "1851454128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10758 WILKINS AVE",
            "address_2": "# 2",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900245060",
            "telephone_number": "310-470-7618",
            "fax_number": "310-273-1189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 WILSHIRE BLVD",
            "address_2": "SUITE 315",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904011872",
            "telephone_number": "310-458-0261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEARD",
        "first_name": "NICOLETTE",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-18",
        "last_updated": "2022-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT25569",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "3975 Old Redwood Hwy",
            "city": "Santa Rosa",
            "state": "CA",
            "country_code": "US",
            "postal_code": "95403",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• The Regents of the University of California
• The Regents of the University of California
• The Regents of the University of California
• The Regents of the University of California
• The Saturday Center for Psychotherapy and Training
• Michelle M Theis-Black, PTA
• Walter Kurt Theis II, M.D.
• Therapeutic Arts Marriage and Family Therapy, Inc.
• Therapy Place 4 Kids
• Therapy Place, P.C.

• Physical Therapist in Santa Monica, CA
• Providers in Santa Monica, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2022; 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.

Verify at the official NPI Registry.