MEDICARE: SOFIA MARIA 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
1	225100000X	Physical Therapist	PT1930	OK

General Provider Information

NPI Number	:	1891015731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOFIA MARIA NICHOLS PT

Provider Business Mailing Address
First Line	:	1105 W APACHE ST
Second Line	:
City	:	NORMAN
State	:	OK
Zip	:	73069-5408
Country	:	US
Telephone Number	:	405-476-9401
Fax Number	:

Provider Business Practice Location Address
First Line	:	409 FRETZ AVE
Second Line	:	SUITE D
City	:	EDMOND
State	:	OK
Zip	:	73003-5570
Country	:	US
Telephone Number	:	405-471-5772
Fax Number	:

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

Provider Enumeration Date	:	06/02/2010
Last Update Date	:	06/02/2010

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