MEDICARE: MR. CHRIS NICHOLAS P.T.

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	4917	SC

General Provider Information

NPI Number	:	1295779676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHRIS NICHOLAS P.T.

Provider Business Mailing Address
First Line	:	212 MARCIE RUSH LN
Second Line	:
City	:	GREER
State	:	SC
Zip	:	29651-6929
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	535 W BUTLER RD
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29607-4833
Country	:	US
Telephone Number	:	864-277-2747
Fax Number	:	864-277-7401

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

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	07/08/2007

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