Healthcare Provider Details

I. General information

NPI: 1982532685
Provider Name (Legal Business Name): NICHOLAS AARON ROOKSTOOL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

979 ROCKY HILL RD
RONCEVERTE WV
24970-8028
US

IV. Provider business mailing address

133 TRAIL LN
WHITE SULPHUR SPRINGS WV
24986-4091
US

V. Phone/Fax

Practice location:
  • Phone: 304-645-7270
  • Fax:
Mailing address:
  • Phone: 304-575-3856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number002259
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: