Healthcare Provider Details

I. General information

NPI: 1811460405
Provider Name (Legal Business Name): LAURA NICOLL PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2019
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 ROUTE 9 S STE 1500
FREEHOLD NJ
07728-4236
US

IV. Provider business mailing address

4400 U.S. 9
FREEHOLD NJ
07728-1227
US

V. Phone/Fax

Practice location:
  • Phone: 732-625-2200
  • Fax:
Mailing address:
  • Phone: 732-625-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01839100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: