Provider Demographics
NPI:1114447901
Name:HESS, NICHOLAS (PT, DPT, CSCS, MS)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:HESS
Suffix:
Gender:M
Credentials:PT, DPT, CSCS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 SUGAR CAMP CIR STE 110
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45409-1979
Mailing Address - Country:US
Mailing Address - Phone:937-227-3174
Mailing Address - Fax:
Practice Address - Street 1:105 SUGAR CAMP CIR STE 110
Practice Address - Street 2:
Practice Address - City:OAKWOOD
Practice Address - State:OH
Practice Address - Zip Code:45409-1979
Practice Address - Country:US
Practice Address - Phone:937-227-3174
Practice Address - Fax:937-227-3174
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-22
Last Update Date:2017-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT0169102251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty