Provider Demographics
NPI:1487698056
Name:SCHERPENBERG, NICHOLE M (LPT)
Entity type:Individual
Prefix:
First Name:NICHOLE
Middle Name:M
Last Name:SCHERPENBERG
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2616 LEGENDS WAY
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41017-2418
Mailing Address - Country:US
Mailing Address - Phone:513-226-3122
Mailing Address - Fax:859-331-9147
Practice Address - Street 1:2616 LEGENDS WAY
Practice Address - Street 2:
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-2418
Practice Address - Country:US
Practice Address - Phone:513-226-3122
Practice Address - Fax:859-331-9147
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-10265225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200871780Medicaid
OH2498720Medicaid
IN200871780Medicaid
OHQ16723Medicare UPIN
IN250700CMedicare PIN
OH2498720Medicaid
OHSC4133831Medicare PIN