MEDICARE: NICHOLE PLUMB LPTA

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	5502001408	MI

General Provider Information

NPI Number	:	1346517133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLE PLUMB LPTA

Provider Business Mailing Address
First Line	:	9543 MCCAIN RD
Second Line	:
City	:	PARMA
State	:	MI
Zip	:	49269-9414
Country	:	US
Telephone Number	:	517-531-3919
Fax Number	:

Provider Business Practice Location Address
First Line	:	9543 MCCAIN RD
Second Line	:
City	:	PARMA
State	:	MI
Zip	:	49269-9414
Country	:	US
Telephone Number	:	517-531-3919
Fax Number	:

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

Provider Enumeration Date	:	11/21/2011
Last Update Date	:	11/21/2011

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Directions to “ NICHOLE PLUMB LPTA” Practice Location

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