MEDICARE: NICOLE SPEARS PT, DPT

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	17228	NC

General Provider Information

NPI Number	:	1942021811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE SPEARS PT, DPT

Provider Business Mailing Address
First Line	:	110 PRIDES CRSG
Second Line	:
City	:	ROLESVILLE
State	:	NC
Zip	:	27571-9739
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2722 SPRING FOREST RD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27616-1977
Country	:	US
Telephone Number	:	919-863-7770
Fax Number	:

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

Provider Enumeration Date	:	10/22/2024
Last Update Date	:	10/22/2024

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