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NPI Code Detail

MEDICARE: MRS. ELIZABETH ANN NICHOLS PT

MEDICARE: MRS. ELIZABETH ANN NICHOLS 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
1225100000XPhysical TherapistP3905NC

General Provider Information

NPI Number : 1871579821
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ELIZABETH ANN NICHOLS PT
Provider Business Mailing Address
First Line : PO BOX 601791
Second Line :
City : CHARLOTTE
State : NC
Zip : 28260-1791
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2400 W MALLARD CREEK CHURCH RD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28262-2324
Country : US
Telephone Number : 704-323-2108
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/21/2005
Last Update Date : 12/17/2024

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