Provider Demographics
NPI:1023564549
Name:NICKLES, LAURA (PT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:NICKLES
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 1:100 SPRUNT ST
Mailing Address - Street 2:UNC THERAPY SERVICES AT UNC WELLNESS CENTER
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-7811
Mailing Address - Country:US
Mailing Address - Phone:984-974-5300
Mailing Address - Fax:984-974-5305
Practice Address - Street 1:100 SPRUNT ST
Practice Address - Street 2:UNC THERAPY SERVICES AT UNC WELLNESS CENTER
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-7811
Practice Address - Country:US
Practice Address - Phone:984-974-5300
Practice Address - Fax:984-974-5305
Is Sole Proprietor?:No
Enumeration Date:2016-08-26
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16580225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist