MEDICARE: KATHLEEN NIKOUKARY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1104519206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN NIKOUKARY

Provider Business Mailing Address
First Line	:	1200 CORPORATE DR STE 400
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35242-5424
Country	:	US
Telephone Number	:	423-682-8840
Fax Number	:

Provider Business Practice Location Address
First Line	:	908 SMITHFIELD WAY STE 104
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29715-6956
Country	:	US
Telephone Number	:	803-470-4933
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2023
Last Update Date	:	06/02/2023

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Directions to “ KATHLEEN NIKOUKARY ” Practice Location

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