Provider Demographics
NPI:1336322726
Name:CHENNAULT, NICHOLE MICHELLE (MPT)
Entity Type:Individual
Prefix:MRS
First Name:NICHOLE
Middle Name:MICHELLE
Last Name:CHENNAULT
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:NICHOLE
Other - Middle Name:MICHELLE
Other - Last Name:HODSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:701 W CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-6015
Mailing Address - Country:US
Mailing Address - Phone:559-713-6806
Mailing Address - Fax:559-713-6809
Practice Address - Street 1:323 N 11TH AVE
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-4511
Practice Address - Country:US
Practice Address - Phone:559-772-8304
Practice Address - Fax:559-530-3239
Is Sole Proprietor?:No
Enumeration Date:2007-12-10
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA238152251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic