MEDICARE: NICHOLAS A WARDLE 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	225100000X	Physical Therapist	PT022031	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588911796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS A WARDLE DPT

Provider Business Mailing Address
First Line	:	20 PARK PL
Second Line	:	SUITE 2
City	:	SHIPPENSBURG
State	:	PA
Zip	:	17257-9806
Country	:	US
Telephone Number	:	717-477-8030
Fax Number	:	717-477-8040

Provider Business Practice Location Address
First Line	:	118 WALNUT ST
Second Line	:	UNIT 114
City	:	WAYNESBORO
State	:	PA
Zip	:	17268-1669
Country	:	US
Telephone Number	:	717-655-5681
Fax Number	:	717-655-5691

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

Provider Enumeration Date	:	08/07/2012
Last Update Date	:	07/06/2015

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Directions to “ NICHOLAS A WARDLE DPT” Practice Location

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