Provider Demographics
NPI:1013373653
Name:FLYNN, NICOLE (DPT, PT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:FLYNN
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:GRIFFIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1011 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:COLLINGDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19023-3932
Mailing Address - Country:US
Mailing Address - Phone:484-995-6057
Mailing Address - Fax:
Practice Address - Street 1:146 MARPLE RD
Practice Address - Street 2:
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-2040
Practice Address - Country:US
Practice Address - Phone:610-356-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-12
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT024938225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist