Provider Demographics
NPI:1124222740
Name:NICKEL, LEE A (MPT)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:A
Last Name:NICKEL
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 24809
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77229-4809
Mailing Address - Country:US
Mailing Address - Phone:713-378-0667
Mailing Address - Fax:832-242-9515
Practice Address - Street 1:2918 SAN JACINTO ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-2708
Practice Address - Country:US
Practice Address - Phone:713-652-3145
Practice Address - Fax:713-652-3146
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1135762225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist