Healthcare Provider Details

I. General information

NPI: 1811409600
Provider Name (Legal Business Name): NICHOLAS GEORGE DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2017
Last Update Date: 11/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5006 ATWOOD DR STE 2
RICHMOND KY
40475-8179
US

IV. Provider business mailing address

5006 ATWOOD DR STE 2
RICHMOND KY
40475-8179
US

V. Phone/Fax

Practice location:
  • Phone: 859-623-2057
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number007270
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: