Provider Demographics
NPI:1366819914
Name:NICHOLSON, RACHEL (PT, DPT)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:NICHOLSON
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 1:200 W DOUGLAS AVE
Mailing Address - Street 2:STE 1040
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67202-3013
Mailing Address - Country:US
Mailing Address - Phone:316-263-0003
Mailing Address - Fax:316-263-1241
Practice Address - Street 1:101 NW ENGLEWOOD RD
Practice Address - Street 2:STE 110
Practice Address - City:GLADSTONE
Practice Address - State:MO
Practice Address - Zip Code:64118-4054
Practice Address - Country:US
Practice Address - Phone:816-413-0900
Practice Address - Fax:816-413-0737
Is Sole Proprietor?:No
Enumeration Date:2015-08-31
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015027169225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist