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General NPI Number Information
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NPI Number | 1639996838
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Entity Type | Individual
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Provider Name | BROOKE RENEE NICHOLSON DPT, PT
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Gender | Female
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Dates
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Enumeration Date | 09/20/2024
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Last Update Date | 11/11/2024
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Provider Practice Location Address
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Address Line | 1109 FRONTIER CIR E STE B
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City | LAKE STEVENS
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State | WA
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Zip | 98258-3442
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Country | US
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Telephone | 425-609-8075
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Fax | 425-947-5928
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Provider Business Mailing Address
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Address Line | 1300 W SAM HOUSTON PKWY S STE 300
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City | HOUSTON
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State | TX
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Zip | 77042-2453
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Country | US
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Telephone | 425-609-8075
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Fax | 425-947-5928
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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 | PT61610267
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License Number State | WA
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