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NPI Code Detail

MEDICARE: MS. ANN G NICHOLSON DPT

MEDICARE: MS. ANN G NICHOLSON 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
1225100000XPhysical TherapistPT60231948WA

General Provider Information

NPI Number : 1508046319
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ANN G NICHOLSON DPT
Provider Business Mailing Address
First Line : 5704 E LAKE SAMMAMISH PKWY SE
Second Line : STE. # 101
City : ISSAQUAH
State : WA
Zip : 98029-8941
Country : US
Telephone Number : 425-270-3323
Fax Number : 425-270-3326
Provider Business Practice Location Address
First Line : 5704 E LAKE SAMMAMISH PKWY SE
Second Line : STE. #101
City : ISSAQUAH
State : WA
Zip : 98029-8941
Country : US
Telephone Number : 425-270-3323
Fax Number : 425-270-3326
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/08/2007
Last Update Date : 09/07/2011

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Directions to “ MS. ANN G NICHOLSON DPT” Practice Location

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