Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Nicollette Penner, DPT

Individual provider Physical Therapist · NPI 1174155568

Nicollette Penner, DPT is a Physical Therapist in Private Practice in San Diego, California. Qualified in 2016, 10 years ago. Practices with Gtms Fitness Corporation, a 13-clinician group and accepts Medicare assignment. Licensed in California.

Years since qualifying
10
Licensed in
CA
In the registry since
2020
What do these letters mean?
DPT — Doctor of Physical Therapy
The doctoral degree now required to enter physical therapy practice.

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Practice location Address checks out

15004 Innovation Dr
San Diego, CA 92128
Phone: (858) 605-7189
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence 292631 (CA)

Record details

NPI number1174155568
Entity typeIndividual (Type 1)
GenderFemale
Credentials DPT
Sole proprietorNo
NPI enumeratedFebruary 4, 2020
Last updated in NPPESFebruary 4, 2020
Certification dateFebruary 4, 2020

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2016 (10 years in practice)
Group practice Gtms Fitness Corporation — 13 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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