Provider Demographics
NPI:1124031703
Name:HAROLD, NICHOLE MARIE (PT)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:MARIE
Last Name:HAROLD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:NICHOLE
Other - Middle Name:MARIE
Other - Last Name:GORSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 39
Mailing Address - Street 2:
Mailing Address - City:TERRA CEIA
Mailing Address - State:FL
Mailing Address - Zip Code:34250-0039
Mailing Address - Country:US
Mailing Address - Phone:941-758-2111
Mailing Address - Fax:941-758-2082
Practice Address - Street 1:5108 BEACON RD
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221-8764
Practice Address - Country:US
Practice Address - Phone:941-758-2111
Practice Address - Fax:941-758-2082
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT9488225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU0360ZMedicare ID - Type Unspecified
FLU0360YMedicare ID - Type Unspecified