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General NPI Number Information
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NPI Number | 1942331368
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Entity Type | Organization
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Legal Business Name | NICHOLSON PSYCHOPHYSIOLOGICAL REHAB
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 03/24/2008
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Provider Practice Location Address
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Address Line | 5956 E PIMA ST SUITE 130
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City | TUCSON
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State | AZ
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Zip | 85712
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Country | US
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Telephone | 520-722-2892
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Fax | 520-722-2873
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Provider Business Mailing Address
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Address Line | PO BOX 30755
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City | TUCSON
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State | AZ
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Zip | 85751-0755
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Country | US
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Telephone | 520-722-2892
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Fax | 520-722-2873
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Authorized Official
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Title or Position | OWNER
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Name | DR. ELAINE RUTHE NICHOLSON
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Credential | PHD
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Telephone | 520-722-2892
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 0857
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License Number State | AZ
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