Federico Nicholas, PTA20728

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA20728 Issued in FL

Practice address

1441 Fortune Rd, #256
Kissimmee, FL 34743

Phone

(352) 787-3188

Fax

(877) 399-5578

NPI assigned

May 11, 2009

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Mr. Federico Nicholas Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Networks

• Freedom Health HMO Network

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

{
    "created_epoch": "1242000000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1433721600000",
    "number": "1891929402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1441 FORTUNE RD, #256",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "34743",
            "telephone_number": "352-787-3188",
            "fax_number": "877-399-5578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1441 FORTUNE RD, #256",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "34743",
            "telephone_number": "352-787-3188",
            "fax_number": "877-399-5578"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLAS",
        "first_name": "FEDERICO",
        "name_prefix": "Mr.",
        "credential": "PTA20728",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-05-11",
        "last_updated": "2015-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "FL",
            "license": "PTA20728",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID",
            "identifier": "106898",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "FEDERICO",
            "last_name": "NICHOLAS",
            "prefix": "MR.",
            "credential": "PTA20728",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Phuong Thanh Thi Nguyen, NURSE PRACTITIONER
• Thu Nguyen
• Tracy Nguyen
• Van Nguyen
• VI Thao Nguyen, OD
• Chyna Nichols
• Aldrea Y Nicholson
• Isaiah Nicholson
• James Nickson
• Roberto A Nicodemo, PA

• Physical Therapy Assistant in Kissimmee, FL
• Providers in Kissimmee, FL by specialty
• Physical Therapy Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2015; 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.