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NPI Code Detail

MEDICARE: NICHOLAS THIEL PTA

MEDICARE: NICHOLAS THIEL PTA
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
1225200000XPhysical Therapy Assistant2536-19WI

General Provider Information

NPI Number : 1922546712
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICHOLAS THIEL PTA
Provider Business Mailing Address
First Line : 19395 W CAPITOL DR
Second Line : STE 200
City : BROOKFIELD
State : WI
Zip : 53045-2736
Country : US
Telephone Number : 262-923-7101
Fax Number : 262-923-7179
Provider Business Practice Location Address
First Line : N4231 STATE HIGHWAY 22
Second Line :
City : SHAWANO
State : WI
Zip : 54166-6130
Country : US
Telephone Number : 715-526-3158
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/01/2017
Last Update Date : 02/01/2017

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Directions to “ NICHOLAS THIEL PTA” Practice Location

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