Provider Demographics
NPI:1457680803
Name:REUSS, NICHOLAS JOSEPH (MS, ATC, CKTP)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:JOSEPH
Last Name:REUSS
Suffix:
Gender:M
Credentials:MS, ATC, CKTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-2701
Mailing Address - Country:US
Mailing Address - Phone:859-233-8850
Mailing Address - Fax:859-233-8238
Practice Address - Street 1:1221 S BROADWAY
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-2701
Practice Address - Country:US
Practice Address - Phone:859-233-8850
Practice Address - Fax:859-233-8238
Is Sole Proprietor?:No
Enumeration Date:2009-12-14
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT0026252255A2300X
KYAT9322255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer