Susan Annette Nickelson, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

P160975894 Issued in WA

Practice address

3901 Kern Way Ste 102
Yakima, WA 98902-7804

Phone

(509) 895-7449

NPI assigned

Sep 9, 2021

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

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.

• Aegis Physical Therapy Inc. PS

  • Physical Therapy Clinic/Center
  • Yakima, WA
  • NPI 1437330339
  NPD

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

{
    "created_epoch": "1631145600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631145600000",
    "number": "1952070245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3901 KERN WAY STE 102",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989027804",
            "telephone_number": "509-895-7449",
            "fax_number": "509-895-7452"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3901 KERN WAY STE 102",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989027804",
            "telephone_number": "509-895-7449"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICKELSON",
        "first_name": "SUSAN",
        "middle_name": "ANNETTE",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-09",
        "last_updated": "2021-09-09",
        "certification_date": "2021-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "WA",
            "license": "P160975894",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thao Nguyen, PHARMD
• Tin Nguyen, DMD
• Yennie Nguyen
• Njui Tabi Ngwi Tanyi, NURSE PRACTITIONER
• Patricia Ann Nichols, PA-C
• Maude Laverne Nickoloff, CDP
• Daniel Nicoara, DO
• Nicolas K Reep DDS PS
• Jean Bernard Nicolas Jr.
• Michael Niemela, CO60707531

• Physical Therapy Assistant in Yakima, WA
• Providers in Yakima, WA by specialty
• Physical Therapy Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2021; 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.