Provider Demographics
NPI:1033586375
Name:NICHOLS, ALLISON LEIGH (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:LEIGH
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 AVERY ST
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-1005
Mailing Address - Country:US
Mailing Address - Phone:617-375-8644
Mailing Address - Fax:617-375-8581
Practice Address - Street 1:4 AVERY ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1005
Practice Address - Country:US
Practice Address - Phone:617-375-8644
Practice Address - Fax:617-375-8581
Is Sole Proprietor?:No
Enumeration Date:2015-08-21
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21919225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA235746OtherTUFTS HEALTH PLAN
MAS400254912Medicare PIN