Provider Demographics
NPI:1073816047
Name:PAWOL, NOLA (PT)
Entity Type:Individual
Prefix:
First Name:NOLA
Middle Name:
Last Name:PAWOL
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 1:2217 DILLON RD
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-9454
Mailing Address - Country:US
Mailing Address - Phone:575-769-7356
Mailing Address - Fax:575-769-7289
Practice Address - Street 1:2217 DILLON RD
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-9454
Practice Address - Country:US
Practice Address - Phone:575-769-7356
Practice Address - Fax:575-769-7289
Is Sole Proprietor?:No
Enumeration Date:2010-12-14
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist