Provider Demographics
NPI:1275880486
Name:LAIRD, NICOLE E (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:E
Last Name:LAIRD
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 RIVERWALK DR STE 312
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-6936
Mailing Address - Country:US
Mailing Address - Phone:512-268-9130
Mailing Address - Fax:833-437-4389
Practice Address - Street 1:324 RIVERWALK DR STE 312
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-6936
Practice Address - Country:US
Practice Address - Phone:512-268-9130
Practice Address - Fax:833-437-4389
Is Sole Proprietor?:No
Enumeration Date:2012-08-07
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1218061225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist