Provider Demographics
NPI:1285201715
Name:ANDRIOLO, NICHOLE ALEXANDRA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:ALEXANDRA
Last Name:ANDRIOLO
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 1:1510 ROUNDUP BLVD
Mailing Address - Street 2:
Mailing Address - City:BELGRADE
Mailing Address - State:MT
Mailing Address - Zip Code:59714-7729
Mailing Address - Country:US
Mailing Address - Phone:406-581-2433
Mailing Address - Fax:
Practice Address - Street 1:4515 VALLEY COMMONS DR STE 101
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-4531
Practice Address - Country:US
Practice Address - Phone:406-404-1897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPTP-PT-LIC-21600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist