MEDICARE: MR. NICHOLAS FRANCIS ALFORD

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	225200000X	Physical Therapy Assistant	0013371	CO

General Provider Information

NPI Number	:	1659784403
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NICHOLAS FRANCIS ALFORD

Provider Business Mailing Address
First Line	:	9657 N COUNTY ROAD 2080E
Second Line	:
City	:	ASHMORE
State	:	IL
Zip	:	61912-9144
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9657 N COUNTY ROAD 2080E
Second Line	:
City	:	ASHMORE
State	:	IL
Zip	:	61912-9144
Country	:	US
Telephone Number	:	217-549-3985
Fax Number	:

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

Provider Enumeration Date	:	06/10/2014
Last Update Date	:	06/10/2014

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