Healthcare Provider Details

I. General information

NPI: 1477195097
Provider Name (Legal Business Name): NICHOLE WAXMAN DPT, LATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICHOLE WAXMAN DPT

II. Dates (important events)

Enumeration Date: 10/15/2019
Last Update Date: 02/15/2023
Certification Date: 02/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 QUAKER HWY
UXBRIDGE MA
01569-1628
US

IV. Provider business mailing address

19 SALO TER
MILLBURY MA
01527-1940
US

V. Phone/Fax

Practice location:
  • Phone: 508-278-7810
  • Fax:
Mailing address:
  • Phone: 774-277-1095
  • Fax: 508-297-8416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2921
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number24512
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: