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NPI Code Detail

MEDICARE: NIKIA RENE CHENNAULT PT, DPT, MPH

MEDICARE: NIKIA RENE CHENNAULT PT, DPT, MPH
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
1225100000XPhysical Therapist14052MN
2225100000XPhysical Therapist2305214582VA
3225100000XPhysical TherapistPT033428PA

General Provider Information

NPI Number : 1164101424
Entity Type Code : Individual
Provider Name (Legal Business Name) : NIKIA RENE CHENNAULT PT, DPT, MPH
Provider Business Mailing Address
First Line : 95 MEDICAL PARK BLVD
Second Line :
City : PETERSBURG
State : VA
Zip : 23805-9280
Country : US
Telephone Number : 804-504-8100
Fax Number :
Provider Business Practice Location Address
First Line : 95 MEDICAL PARK BLVD
Second Line :
City : PETERSBURG
State : VA
Zip : 23805-9280
Country : US
Telephone Number : 804-504-8100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2023
Last Update Date : 06/01/2026

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