NICHOLAS JAMES PETERSON (PT) – Physical Therapist, NPI 1053035261

NICHOLAS JAMES PETERSON (PT) is a healthcare provider. based in La crosse, Wisconsin. specializing in PHYSICAL THERAPIST IN PRIVATE PRACTICE. They hold the professional credentials PT. They hold a License No. 13206 (MN). The NPI Number for NICHOLAS JAMES PETERSON (PT) is 1053035261

Main info

Male
4 Years Of Experience
Accepts Medicare Assignment
Name
NICHOLAS JAMES PETERSON (PT)
NPI
1053035261
Phone
(608) 782-7300
Address
1836 SOUTH AVE
Enumeration Date
30 September 2022
Last Update Date
1 August 2023

Doctor Profile

Medical School Name
OTHER
Secondary Phone
9072357473
Graduation Year
2022 (4 years ago)
PAC ID
9032571542
Group Practice PAC ID
5597029793
Professional Enrollment ID
I20240501000832
Address ID
AK996037694HO601XXAVEX402
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience39
Completeness75
Years active:3State licenses:2Digital endpointsOther names

1,991 PHYSICAL THERAPIST IN PRIVATE PRACTICE in WI

Provider Addresses for NICHOLAS JAMES PETERSON (PT)

  • 1836 SOUTH AVE

    LA CROSSE, WI 546015429

    Phone: (608) 782-7300

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2024-05-01

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20240501000832IPhysical Therapist In Private PracticeAKTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
97110Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes9116$0
View full utilization report →

Insurance plans in this area (ZIP 54601)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 5597029793View full group profile
NameSpecialtyState
Physical Therapist In Private PracticeIL
Physical Therapist In Private PracticePA
Physical Therapist In Private PracticeAK
Physical Therapist In Private PracticeAK
Physical Therapist In Private PracticeAK
-AK
Physical Therapist In Private PracticeAK
Physical Therapist In Private PracticeAL
Physical Therapist In Private PracticeIA
Physical Therapist In Private PracticeCA

Reviews

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Frequently asked questions

Can I use this page to confirm NICHOLAS JAMES PETERSON (PT)'s NPI?
Yes. NICHOLAS JAMES PETERSON (PT) is listed with NPI 1053035261 in the public NPI dataset.
Is NICHOLAS JAMES PETERSON (PT) listed as active for patients and plans?
The listing shows NICHOLAS JAMES PETERSON (PT) as active in the NPI system.
What is NICHOLAS JAMES PETERSON (PT)'s primary classification?
Physical Therapist is the headline specialty for NICHOLAS JAMES PETERSON (PT) here. Clinical services aligned with this taxonomy classification.
What area does NICHOLAS JAMES PETERSON (PT) serve?
NICHOLAS JAMES PETERSON (PT)'s listing highlights La Crosse, Wisconsin; more addresses can appear in NPPES.
How many locations tie to this NPI?
2 practice locations appear in the available data.

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