Provider Demographics
NPI:1053432575
Name:HECOCK, NICOLE COLLEEN (PT)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:COLLEEN
Last Name:HECOCK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1180
Mailing Address - Street 2:
Mailing Address - City:THREE FORKS
Mailing Address - State:MT
Mailing Address - Zip Code:59752-1180
Mailing Address - Country:US
Mailing Address - Phone:406-285-0626
Mailing Address - Fax:406-285-3500
Practice Address - Street 1:203 S MAIN ST
Practice Address - Street 2:
Practice Address - City:THREE FORKS
Practice Address - State:MT
Practice Address - Zip Code:59752-9111
Practice Address - Country:US
Practice Address - Phone:406-285-0626
Practice Address - Fax:406-285-3500
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1278225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0345032Medicaid
MT00006191-6OtherBCBS
MT00006191-6OtherBCBS
MT011001649Medicare PIN