MEDICARE: NICOLE CHRISTINE TETREAULT DPT

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	1236460	TX
2	225100000X	Physical Therapist	38665	CA

General Provider Information

NPI Number	:	1205106333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE CHRISTINE TETREAULT DPT

Provider Business Mailing Address
First Line	:	1301 AIRPORT FWY # 100
Second Line	:
City	:	BEDFORD
State	:	TX
Zip	:	76021-6624
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1301 AIRPORT FWY # 100
Second Line	:
City	:	BEDFORD
State	:	TX
Zip	:	76021-6624
Country	:	US
Telephone Number	:	972-677-3499
Fax Number	:

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

Provider Enumeration Date	:	01/05/2012
Last Update Date	:	02/06/2026

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Directions to “ NICOLE CHRISTINE TETREAULT DPT” Practice Location

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