Provider Demographics
NPI:1194182246
Name:LAMBERTH, NICHOLE GRICE (MPT)
Entity Type:Individual
Prefix:MRS
First Name:NICHOLE
Middle Name:GRICE
Last Name:LAMBERTH
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 1:1911 LIMEKILN RD
Mailing Address - Street 2:
Mailing Address - City:TENNESSEE RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37178-5521
Mailing Address - Country:US
Mailing Address - Phone:931-721-3402
Mailing Address - Fax:931-721-3402
Practice Address - Street 1:3507 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ERIN
Practice Address - State:TN
Practice Address - Zip Code:37061-4148
Practice Address - Country:US
Practice Address - Phone:931-289-5460
Practice Address - Fax:931-289-5461
Is Sole Proprietor?:No
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN66752251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic