Provider Demographics
NPI:1154823094
Name:NICHOLS, CHRISTOPHER J (PT)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:J
Last Name:NICHOLS
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 1:1809 N BINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-1764
Mailing Address - Country:US
Mailing Address - Phone:208-466-6959
Mailing Address - Fax:208-465-9901
Practice Address - Street 1:1809 N BINGHAM DR
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-1764
Practice Address - Country:US
Practice Address - Phone:208-466-6959
Practice Address - Fax:208-465-9901
Is Sole Proprietor?:No
Enumeration Date:2018-03-07
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10636251-2401225100000X
IDPT7186225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist