MEDICARE: NICHOLE FLOWERS PTA

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	225200000X	Physical Therapy Assistant	2134040	TX

General Provider Information

NPI Number	:	1154832665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLE FLOWERS PTA

Provider Business Mailing Address
First Line	:	J801 ROAD 3
Second Line	:
City	:	MC CLURE
State	:	OH
Zip	:	43534-9776
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	J801 ROAD 3
Second Line	:
City	:	MC CLURE
State	:	OH
Zip	:	43534-9776
Country	:	US
Telephone Number	:	419-906-2086
Fax Number	:

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

Provider Enumeration Date	:	10/24/2017
Last Update Date	:	10/24/2017

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Directions to “ NICHOLE FLOWERS PTA” Practice Location

Language	Start Address	Practice Location

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