Provider Demographics
NPI:1053018168
Name:STOTTS, NICOLE (PT, DPT, GCS, CEEAA)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:STOTTS
Suffix:
Gender:F
Credentials:PT, DPT, GCS, CEEAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 UNIVERSITY PKWY
Mailing Address - Street 2:DEPT OF PHYSICAL THERAPY
Mailing Address - City:UNIVERSITY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60484
Mailing Address - Country:US
Mailing Address - Phone:708-534-3147
Mailing Address - Fax:
Practice Address - Street 1:20201 S CRAWFORD AVE
Practice Address - Street 2:INPATIENT THERAPY SERVICES
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461
Practice Address - Country:US
Practice Address - Phone:708-747-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070018928225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist