Active NPI
Nicole Fetterer
- Physical Therapist
- Centreville, MI
National Provider Identifier
1972410181
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 5501018358
- Practice address
- 62445 Shimmel Rd
Centreville, MI 49032-9527 - Phone
- (616) 510-9183
- NPI assigned
- Aug 25, 2026
- Sex
- Unspecified or another gender identity
- 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 | 5501018358 | MI | Primary |
Addresses
Primary practice location
62445 Shimmel Rd
Centreville, MI 49032-9527
Mailing address
3905 Jennings Dr
Kalamazoo, MI 49048-1080
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1787616000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1787616000000",
"number": "1972410181",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3905 JENNINGS DR",
"city": "KALAMAZOO",
"state": "MI",
"postal_code": "490481080"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "62445 SHIMMEL RD",
"city": "CENTREVILLE",
"state": "MI",
"postal_code": "490329527",
"telephone_number": "616-510-9183"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FETTERER",
"first_name": "NICOLE",
"sole_proprietor": "NO",
"sex": "X",
"enumeration_date": "2026-08-25",
"last_updated": "2026-08-25",
"certification_date": "2026-08-25",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MI",
"license": "5501018358",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Centreville, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.