Provider Demographics
NPI:1477662062
Name:NICHOLS, DIANA LYNN (PT)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:LYNN
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42577 LONDON DR
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-4720
Mailing Address - Country:US
Mailing Address - Phone:303-841-6309
Mailing Address - Fax:
Practice Address - Street 1:7340 S ALTON WAY # 11-D
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-2335
Practice Address - Country:US
Practice Address - Phone:720-493-1181
Practice Address - Fax:720-493-1191
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO3199OtherLICENSE #