Healthcare Provider Details

I. General information

NPI: 1477807345
Provider Name (Legal Business Name): TERRY EMANUEL NICHOLS P.T.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2012
Last Update Date: 01/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 CARTWRIGHT RD SUITE 606
MISSOURI CITY TX
77459-3541
US

IV. Provider business mailing address

PO BOX 19155
SUGAR LAND TX
77496-9155
US

V. Phone/Fax

Practice location:
  • Phone: 281-969-7137
  • Fax: 281-969-8882
Mailing address:
  • Phone: 281-969-7137
  • Fax: 281-969-8882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number2087210
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: