Healthcare Provider Details

I. General information

NPI: 1548244775
Provider Name (Legal Business Name): JULIE LYNN NICHOLS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 04/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1082 BOWER HILL RD
PITTSBURGH PA
15243-1324
US

IV. Provider business mailing address

430 INNOVATION DRIVE
BLAIRSVILLE PA
15717-8096
US

V. Phone/Fax

Practice location:
  • Phone: 412-429-9775
  • Fax: 412-429-9776
Mailing address:
  • Phone: 724-343-4060
  • Fax: 724-343-4069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number10149
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: