MEDICARE: NICOLE MCLEOD PT

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	2251P0200X	Pediatric Physical Therapist	1159291	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538765052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE MCLEOD PT

Provider Business Mailing Address
First Line	:	2743 SMITH RANCH RD STE 701
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-5210
Country	:	US
Telephone Number	:	713-433-7406
Fax Number	:

Provider Business Practice Location Address
First Line	:	2743 SMITH RANCH RD STE 701
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-5204
Country	:	US
Telephone Number	:	713-433-7406
Fax Number	:

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

Provider Enumeration Date	:	12/09/2020
Last Update Date	:	02/07/2022

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Directions to “ NICOLE MCLEOD PT” Practice Location

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