MEDICARE: NICOLE WADE PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	18549	MD
2	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1053514802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE WADE PT

Provider Business Mailing Address
First Line	:	PO BOX 9987
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22304-0067
Country	:	US
Telephone Number	:	703-672-1883
Fax Number	:

Provider Business Practice Location Address
First Line	:	8001 LYNBROOK DR
Second Line	:
City	:	BETHESDA
State	:	MD
Zip	:	20814-4642
Country	:	US
Telephone Number	:	240-740-5500
Fax Number	:	301-657-4971

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2007
Last Update Date	:	09/17/2024

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Directions to “ NICOLE WADE PT” Practice Location

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