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General NPI Number Information
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NPI Number | 1255412904
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Entity Type | Individual
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Provider Name | TERRENCE DUWAYNE NICKENS DPT
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Gender | Male
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 04/29/2025
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Provider Practice Location Address
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Address Line | 6455 S FRY RD STE 102
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City | KATY
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State | TX
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Zip | 77494-8322
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Country | US
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Telephone | 281-731-8112
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Fax |
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Provider Business Mailing Address
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Address Line | 1200 CORPORATE DR STE 400
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City | HOOVER
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State | AL
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Zip | 35242-5424
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Country | US
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Telephone | 423-238-7217
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Fax | 601-956-0139
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | PT3573
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License Number State | MS
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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 | 1222302
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License Number State | TX
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