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General NPI Number Information
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NPI Number | 1083865265
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Entity Type | Individual
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Provider Name | NICOLE SIMONE WESTON DPT
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Gender | Female
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Dates
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Enumeration Date | 10/06/2008
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Last Update Date | 01/29/2016
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Provider Practice Location Address
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Address Line | 800 SPRING CREEK BLVD APARTMENT 10208
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City | CRESTVIEW
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State | FL
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Zip | 32536-5175
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Country | US
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Telephone | 269-240-8855
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Fax |
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Provider Business Mailing Address
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Address Line | 800 SPRING CREEK BLVD APARTMENT 10208
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City | CRESTVIEW
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State | FL
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Zip | 32536-5175
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Country | US
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Telephone | 269-240-8855
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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 | 22374
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501015863
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 05010738A
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License Number State | IN
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Taxonomy #4
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 31106
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License Number State | FL
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