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General NPI Number Information
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NPI Number | 1043449903
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Entity Type | Individual
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Provider Name | ERIN ANN NICKENIG PT, DPT, BCB-PMD
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Gender | Female
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Dates
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Enumeration Date | 07/13/2009
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Last Update Date | 01/02/2026
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Provider Practice Location Address
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Address Line | 210 N WALTON BLVD STE 26
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City | BENTONVILLE
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State | AR
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Zip | 72712-5081
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Country | US
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Telephone | 479-440-4147
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Fax |
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Provider Business Mailing Address
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Address Line | 210 N WALTON BLVD STE 26
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City | BENTONVILLE
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State | AR
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Zip | 72712-5081
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Country | US
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Telephone | 479-440-4147
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 3482
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License Number State | AR
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