Provider Demographics
NPI:1407828122
Name:FRY, NICOLE LEIGH (PT)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:LEIGH
Last Name:FRY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:NICOLE
Other - Middle Name:LEIGH
Other - Last Name:WEBSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2843 OBSERVATORY AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45208-2332
Mailing Address - Country:US
Mailing Address - Phone:513-289-6848
Mailing Address - Fax:
Practice Address - Street 1:9363 ALLEN RD
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-3846
Practice Address - Country:US
Practice Address - Phone:513-870-0039
Practice Address - Fax:513-870-0452
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT 010001225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHFR4159181Medicare ID - Type Unspecified