Healthcare Provider Details

I. General information

NPI: 1780616839
Provider Name (Legal Business Name): ALLISON C NICKLIN-TOBIN PT DPT MTC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALLISON C NICKLIN DPT MTC

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 04/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 PRINTERS PARKWAY SUITE 125
COLORADO SPRINGS CO
80910
US

IV. Provider business mailing address

155 PRINTERS PKWY SUITE 125
COLORADO SPRINGS CO
80910-6100
US

V. Phone/Fax

Practice location:
  • Phone: 719-635-8622
  • Fax: 719-635-8619
Mailing address:
  • Phone: 719-635-8622
  • Fax: 719-635-8619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5237DPT
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: