Provider Demographics
NPI:1679148993
Name:NICHOLS PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:NICHOLS PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:208-466-6959
Mailing Address - Street 1:1809 N BINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-1764
Mailing Address - Country:US
Mailing Address - Phone:208-466-6959
Mailing Address - Fax:208-465-9901
Practice Address - Street 1:1809 N BINGHAM DR
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-1764
Practice Address - Country:US
Practice Address - Phone:208-466-6959
Practice Address - Fax:208-465-9901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-20
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty