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General NPI Number Information
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NPI Number | 1154823094
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Entity Type | Individual
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Provider Name | CHRISTOPHER J NICHOLS P.T.
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Gender | Male
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Dates
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Enumeration Date | 03/07/2018
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Last Update Date | 02/16/2021
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Provider Practice Location Address
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Address Line | 1809 N BINGHAM DR
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City | NAMPA
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State | ID
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Zip | 83651-1764
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Country | US
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Telephone | 208-466-6959
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Fax | 208-465-9901
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Provider Business Mailing Address
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Address Line | 1809 N BINGHAM DR
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City | NAMPA
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State | ID
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Zip | 83651-1764
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Country | US
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Telephone | 208-466-6959
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Fax | 208-465-9901
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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 | 10636251-2401
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License Number State | UT
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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 | PT7186
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License Number State | ID
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