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

Individual provider Physical Therapist · NPI 1700949344

Rachael Wiley Nicolaisen, DPT is a Physical Therapist in Private Practice in Los Angeles, California. Qualified in 2003, 23 years ago. Practices with Southern California Permanente Medical Group, an 11,242-clinician group and accepts Medicare assignment. Licensed in California.

Years since qualifying
23
Licensed in
CA
In the registry since
2006
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

6041 Cadillac Ave
Los Angeles, CA 90034-1702
Phone: (541) 521-8867
Fax: (541) 521-8867
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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 28739 (CA)

Record details

NPI number1700949344
Entity typeIndividual (Type 1)
GenderFemale
Credentials DPT
Sole proprietorYes
NPI enumeratedDecember 18, 2006
Last updated in NPPESDecember 2, 2021
Certification dateDecember 2, 2021

Medicare enrollment

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

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2003 (23 years in practice)
Group practice Southern California Permanente Medical Group — 11242 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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