Healthcare Provider Details

I. General information

NPI: 1588330575
Provider Name (Legal Business Name): LYNDSEY BROOKE NICHOLS DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2021
Last Update Date: 08/19/2021
Certification Date: 08/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 SPRING ST SE STE 101
GAINESVILLE GA
30501-3773
US

IV. Provider business mailing address

500 SPRING ST SE STE 101
GAINESVILLE GA
30501-3773
US

V. Phone/Fax

Practice location:
  • Phone: 770-615-7676
  • Fax:
Mailing address:
  • Phone: 770-615-7676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT015544
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: