Healthcare Provider Details

I. General information

NPI: 1699344549
Provider Name (Legal Business Name): NICKOLAS AUSTIN PIPPERT PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2021
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8070 PARK LN STE 130
DALLAS TX
75231-6439
US

IV. Provider business mailing address

3500 OAK LAWN AVE STE 670
DALLAS TX
75219-4399
US

V. Phone/Fax

Practice location:
  • Phone: 469-372-0021
  • Fax: 469-372-0029
Mailing address:
  • Phone: 214-528-3378
  • Fax: 214-528-3379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP038437T
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number1347018
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP031841T
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: