Healthcare Provider Details

I. General information

NPI: 1770488066
Provider Name (Legal Business Name): SHERYL NICHOLS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3504 PINE GROVE AVE
PORT HURON MI
48060-1944
US

IV. Provider business mailing address

3939 N RIVER RD
FORT GRATIOT MI
48059-4151
US

V. Phone/Fax

Practice location:
  • Phone: 810-385-9934
  • Fax: 810-385-5561
Mailing address:
  • Phone: 810-385-9934
  • Fax: 810-434-5561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5502000309
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: