Provider Demographics
NPI:1679689376
Name:NICKEL, PAULA M (MSPT)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:M
Last Name:NICKEL
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:M
Other - Last Name:SOTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:3519 RICHMOND DRIVE #C
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-5994
Mailing Address - Country:US
Mailing Address - Phone:970-493-8727
Mailing Address - Fax:970-493-8739
Practice Address - Street 1:3519 RICHMOND DRIVE #C
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-5994
Practice Address - Country:US
Practice Address - Phone:970-493-8727
Practice Address - Fax:970-493-8739
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2795225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC460278Medicare PIN