Provider Demographics
NPI:1437128931
Name:NICHOLL, JEFF (PT)
Entity Type:Individual
Prefix:MR
First Name:JEFF
Middle Name:
Last Name:NICHOLL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:MR
Other - First Name:JEFF
Other - Middle Name:
Other - Last Name:NICHOLL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:516 LAS POSAS RD
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-5705
Mailing Address - Country:US
Mailing Address - Phone:805-388-5678
Mailing Address - Fax:805-388-5665
Practice Address - Street 1:516 LAS POSAS RD
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-5705
Practice Address - Country:US
Practice Address - Phone:805-388-5678
Practice Address - Fax:805-388-5665
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17739225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist