Provider Demographics
NPI:1013226273
Name:MEYER, NICOLE ANCTIL (PT)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:ANCTIL
Last Name:MEYER
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 1:415 IDLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32176-5441
Mailing Address - Country:US
Mailing Address - Phone:386-677-7796
Mailing Address - Fax:386-676-1135
Practice Address - Street 1:1893 N CLYDE MORRIS BLVD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-5535
Practice Address - Country:US
Practice Address - Phone:386-676-0307
Practice Address - Fax:386-676-1135
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT19413261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy