MEDICARE: NICOLE CARGILL PT, 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	2251X0800X	Orthopedic Physical Therapist	15095	CO

General Provider Information

NPI Number	:	1518483072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE CARGILL PT, DPT

Provider Business Mailing Address
First Line	:	6268 TWIN OAKS DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-8305
Country	:	US
Telephone Number	:	330-388-3299
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 S WEBER ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-1902
Country	:	US
Telephone Number	:	719-630-7774
Fax Number	:

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

Provider Enumeration Date	:	08/16/2017
Last Update Date	:	08/16/2017

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