Provider Demographics
NPI: | 1003899782 |
---|---|
Name: | COLDICOTT, NANCY LEIGH (PT) |
Entity Type: | Individual |
Prefix: | MRS |
First Name: | NANCY |
Middle Name: | LEIGH |
Last Name: | COLDICOTT |
Suffix: | |
Gender: | F |
Credentials: | PT |
Other - Prefix: | MRS |
Other - First Name: | NANCY |
Other - Middle Name: | LEIGH |
Other - Last Name: | FIELMAN |
Other - Suffix: | |
Other - Last Name Type: | Former Name |
Other - Credentials: | PT |
Mailing Address - Street 1: | PO BOX 4649 |
Mailing Address - Street 2: | |
Mailing Address - City: | LAGO VISTA |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 78645-0054 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 512-267-5400 |
Mailing Address - Fax: | 512-267-5700 |
Practice Address - Street 1: | 5802 THUNDERBIRD ST |
Practice Address - Street 2: | SUITE A |
Practice Address - City: | LAGO VISTA |
Practice Address - State: | TX |
Practice Address - Zip Code: | 78645-5887 |
Practice Address - Country: | US |
Practice Address - Phone: | 512-267-5400 |
Practice Address - Fax: | 512-267-5700 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2005-11-27 |
Last Update Date: | 2021-01-13 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | 1134674 | 225100000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TX | 659590 | Other | BCBS |
TX | 201463103 | Medicaid | |
TX | 201463102 | Medicaid | |
TX | P22542 | Medicare UPIN |