Healthcare Provider Details

I. General information

NPI: 1073848941
Provider Name (Legal Business Name): MS. NICOLE LYNN AMSLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE A LOVELESS AMSLER

II. Dates (important events)

Enumeration Date: 10/12/2009
Last Update Date: 10/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8820 ANCHOR BAY CT
INDIANAPOLIS IN
46236-8210
US

IV. Provider business mailing address

8820 ANCHOR BAY CT
INDIANAPOLIS IN
46236-8210
US

V. Phone/Fax

Practice location:
  • Phone: 317-826-1853
  • Fax: 317-826-1938
Mailing address:
  • Phone: 317-826-1853
  • Fax: 317-826-1938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05007321A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: