Healthcare Provider Details

I. General information

NPI: 1801750336
Provider Name (Legal Business Name): MAX WILLARD NICHOLSON III DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 E 3RD ST
WILLIAMSPORT PA
17701-4088
US

IV. Provider business mailing address

7 DOCK HILL RD
MIDDLEBURG PA
17842-8910
US

V. Phone/Fax

Practice location:
  • Phone: 570-360-5915
  • Fax: 570-560-6501
Mailing address:
  • Phone: 570-837-2123
  • Fax: 570-837-2185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: