Provider Demographics
NPI:1164101424
Name:CHENNAULT, NIKIA RENE (PT, DPT, MPH)
Entity Type:Individual
Prefix:DR
First Name:NIKIA
Middle Name:RENE
Last Name:CHENNAULT
Suffix:
Gender:F
Credentials:PT, DPT, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 MEDICAL PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23805-9280
Mailing Address - Country:US
Mailing Address - Phone:804-504-8100
Mailing Address - Fax:
Practice Address - Street 1:95 MEDICAL PARK BLVD
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-9280
Practice Address - Country:US
Practice Address - Phone:804-504-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-13
Last Update Date:2024-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305214582225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist