Provider Demographics
NPI:1164582805
Name:HUGHES, NICOLE MONIQUE (PT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:MONIQUE
Last Name:HUGHES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14178 RIVER RD
Mailing Address - Street 2:C
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32507-4624
Mailing Address - Country:US
Mailing Address - Phone:251-232-4000
Mailing Address - Fax:850-497-1675
Practice Address - Street 1:6451 MERRITT BLVD
Practice Address - Street 2:B
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-4827
Practice Address - Country:US
Practice Address - Phone:251-621-0882
Practice Address - Fax:251-621-1942
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH2103225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist