Healthcare Provider Details

I. General information

NPI: 1639878838
Provider Name (Legal Business Name): NICOLE NAUERT PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 02/27/2023
Certification Date: 02/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 S 8TH ST
GRIFFIN GA
30224-4884
US

IV. Provider business mailing address

1301 ACADEMIC PKWY APT 4110
LOCUST GROVE GA
30248-2687
US

V. Phone/Fax

Practice location:
  • Phone: 770-229-6498
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT016357
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: