Provider Demographics
NPI:1376534107
Name:RANEY, NICOLE HEATHER (PT, DSC, FAAOMPT)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:HEATHER
Last Name:RANEY
Suffix:
Gender:F
Credentials:PT, DSC, FAAOMPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 EVANS AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-3720
Mailing Address - Country:US
Mailing Address - Phone:210-667-6192
Mailing Address - Fax:
Practice Address - Street 1:WILFORD HALL MEDICAL CENTER
Practice Address - Street 2:2200 BERQUIST DR, PHYSICAL THERAPY CLINIC
Practice Address - City:LACKLAND AFB
Practice Address - State:TX
Practice Address - Zip Code:78236
Practice Address - Country:US
Practice Address - Phone:210-292-5023
Practice Address - Fax:210-292-7991
Is Sole Proprietor?:No
Enumeration Date:2005-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11482972251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic