Provider Demographics
NPI:1407451594
Name:MINYARD, NIKKI KRIS (PT)
Entity Type:Individual
Prefix:
First Name:NIKKI
Middle Name:KRIS
Last Name:MINYARD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:NIKKI KRIS
Other - Middle Name:MALON
Other - Last Name:MAAPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:9880 ANGIES WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-2851
Mailing Address - Country:US
Mailing Address - Phone:502-339-6490
Mailing Address - Fax:630-928-5080
Practice Address - Street 1:9880 ANGIES WAY STE 100
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2851
Practice Address - Country:US
Practice Address - Phone:502-339-6490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-04
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY008482225100000X
IL070025538225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist