Provider Demographics
NPI:1386657013
Name:SLEETH, NICOLE DEANN (MPT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:DEANN
Last Name:SLEETH
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 36TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-1005
Mailing Address - Country:US
Mailing Address - Phone:304-917-3660
Mailing Address - Fax:304-917-3674
Practice Address - Street 1:117 WEST WAGNER STREET
Practice Address - Street 2:
Practice Address - City:ELLENBORO
Practice Address - State:WV
Practice Address - Zip Code:26346
Practice Address - Country:US
Practice Address - Phone:304-869-3888
Practice Address - Fax:304-869-3888
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV002367225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV7305188-000Medicaid
WV7305188-000Medicaid