MEDICARE: MRS. AMBER JOY NICHOLSON PTA

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	598	SC
2	225700000X	Massage Therapist	2623	SC

General Provider Information

NPI Number	:	1922209584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMBER JOY NICHOLSON PTA

Provider Business Mailing Address
First Line	:	3370 LINDNER LN
Second Line	:
City	:	MT PLEASANT
State	:	SC
Zip	:	29466-8678
Country	:	US
Telephone Number	:	843-216-1713
Fax Number	:

Provider Business Practice Location Address
First Line	:	3400 SALTERBECK CT
Second Line	:	SUITE 102
City	:	MT PLEASANT
State	:	SC
Zip	:	29466-7118
Country	:	US
Telephone Number	:	843-971-3373
Fax Number	:	843-971-2806

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

Provider Enumeration Date	:	05/30/2007
Last Update Date	:	09/11/2025

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