MEDICARE: NICOLE R TESSIER 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	225200000X	Physical Therapy Assistant	24243	FL
2	225100000X	Physical Therapist	9474	SC

General Provider Information

NPI Number	:	1295145936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE R TESSIER DPT

Provider Business Mailing Address
First Line	:	470 HULON LANE
Second Line	:	TTN: VP REVENUE CYCLE
City	:	WEST COLUMBIA
State	:	SC
Zip	:	29169
Country	:	US
Telephone Number	:	803-791-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	130 FORUM DR STE 113
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29229-7943
Country	:	US
Telephone Number	:	803-509-6880
Fax Number	:	803-509-6881

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

Provider Enumeration Date	:	05/03/2014
Last Update Date	:	10/02/2020

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Directions to “ NICOLE R TESSIER DPT” Practice Location

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