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NPI Code Detail

MEDICARE: MS. PATRICIA R NICHOLS RPT, DPT

MEDICARE: MS. PATRICIA R NICHOLS RPT, 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 Therapist1595AL
2225100000XPhysical TherapistPT012279GA

General Provider Information

NPI Number : 1770712853
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. PATRICIA R NICHOLS RPT, DPT
Provider Business Mailing Address
First Line : 2455 OAK GROVE CHURCH RD
Second Line :
City : CARROLLTON
State : GA
Zip : 30117-9513
Country : US
Telephone Number : 334-669-5757
Fax Number :
Provider Business Practice Location Address
First Line : 2455 OAK GROVE CHURCH RD
Second Line :
City : CARROLLTON
State : GA
Zip : 30117-9513
Country : US
Telephone Number : 770-834-1737
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/09/2009
Last Update Date : 10/26/2018

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