Provider Demographics
NPI:1487183935
Name:SAUL, NICHOLAS RICHARD (BS, MSAT)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:RICHARD
Last Name:SAUL
Suffix:
Gender:M
Credentials:BS, MSAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 31
Mailing Address - Street 2:
Mailing Address - City:CLEMSON
Mailing Address - State:SC
Mailing Address - Zip Code:29633-0031
Mailing Address - Country:US
Mailing Address - Phone:630-825-8528
Mailing Address - Fax:
Practice Address - Street 1:100 REEVES WAY
Practice Address - Street 2:
Practice Address - City:CLEMSON
Practice Address - State:SC
Practice Address - Zip Code:29634-3906
Practice Address - Country:US
Practice Address - Phone:630-825-8528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-08
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAT28872255A2300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program