Provider Demographics
NPI:1558301762
Name:SCHMIDT, NICOLE J (MPT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:J
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:SCHMIDT
Other - Middle Name:J
Other - Last Name:SWEET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 6001
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58108-6001
Mailing Address - Country:US
Mailing Address - Phone:701-364-3300
Mailing Address - Fax:701-364-8906
Practice Address - Street 1:3000 32ND AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-6132
Practice Address - Country:US
Practice Address - Phone:701-364-8000
Practice Address - Fax:701-364-8078
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1332225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND6406621OtherMEDICA #
NDHP66226OtherHEALTHPARTNERS #
ND27196OtherNDBS #
ND6406622OtherMEDICA #
ND759S7NIOtherMNBS #
ND24443523OtherAMERICA'S PPO-ARAZ #
ND54336OtherLHS-BANNER HEALTH #
NC51184Medicaid
ND651N3NIOtherMNBS #
NDDA9011015523OtherPREFERRED ONE #
ND6406623OtherMEDICA #
NDHP66226OtherHEALTHPARTNERS #
ND715337Medicare PIN