Jamie Lee Nickerson, DPT
Individual provider Active NPI Physical Therapist · Augusta, ME
NPI 1962996686 · NPPES record last updated Jun 16, 2018
Key facts
- NPI
- 1962996686
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- PT5137 (ME)
- Practice address
- 1 VA Ctr
Augusta, ME 04330-6719 - Phone
- (207) 623-8411
- NPI assigned
- Jun 16, 2018
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT5137 | ME | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT5137 | ME | Yes |
Addresses
Primary practice location
1 VA Ctr
Augusta, ME 04330-6719
Mailing address
102 Skowhegan Rd
Fairfield, ME 04937-3306
Other providers in Augusta, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 16, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.