Provider Demographics
NPI:1275651572
Name:NICHOLSON, GARVICE (PT)
Entity Type:Individual
Prefix:
First Name:GARVICE
Middle Name:
Last Name:NICHOLSON
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 1:8225 44TH AVE W
Mailing Address - Street 2:SUITE C
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-2800
Mailing Address - Country:US
Mailing Address - Phone:425-353-8797
Mailing Address - Fax:425-353-8765
Practice Address - Street 1:8225 44TH AVE W
Practice Address - Street 2:SUITE C
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-2800
Practice Address - Country:US
Practice Address - Phone:425-353-8797
Practice Address - Fax:425-353-8765
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWA00009250225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0182089OtherL&I NUMBER