Provider Demographics
NPI:1114238516
Name:SHIELDS, NICHOLAS ALLEN (PT)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:ALLEN
Last Name:SHIELDS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7550 HILLSIDE
Mailing Address - Street 2:APT. 719
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79119
Mailing Address - Country:US
Mailing Address - Phone:817-301-5990
Mailing Address - Fax:
Practice Address - Street 1:1619 SOUTH KENTUCKY ST.
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79102
Practice Address - Country:US
Practice Address - Phone:806-373-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3109162225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist