Healthcare Provider Details

I. General information

NPI: 1568326478
Provider Name (Legal Business Name): NICOLE TAYLOR JONES DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 OLYMPUS BLVD
COPPELL TX
75019-5472
US

IV. Provider business mailing address

15616 SAN LAZZARO AVE
BRADENTON FL
34211-5846
US

V. Phone/Fax

Practice location:
  • Phone: 866-211-5405
  • Fax:
Mailing address:
  • Phone: 860-819-1430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT44031
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: