Provider Demographics
NPI:1154832665
Name:FLOWERS, NICHOLE (PTA)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:
Last Name:FLOWERS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:J801 ROAD 3
Mailing Address - Street 2:
Mailing Address - City:MC CLURE
Mailing Address - State:OH
Mailing Address - Zip Code:43534-9776
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:J801 ROAD 3
Practice Address - Street 2:
Practice Address - City:MC CLURE
Practice Address - State:OH
Practice Address - Zip Code:43534-9776
Practice Address - Country:US
Practice Address - Phone:419-906-2086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-24
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2134040225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant