Provider Demographics
NPI:1508555418
Name:NICHOLSON, RYLEIGH
Entity Type:Individual
Prefix:
First Name:RYLEIGH
Middle Name:
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-558-0076
Mailing Address - Fax:
Practice Address - Street 1:5013 SOUTHPORT CROSSING WAY STE 204
Practice Address - Street 2:
Practice Address - City:SOUTHPORT
Practice Address - State:NC
Practice Address - Zip Code:28461-2206
Practice Address - Country:US
Practice Address - Phone:910-604-9550
Practice Address - Fax:910-338-3112
Is Sole Proprietor?:No
Enumeration Date:2023-05-05
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH11593225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist