Provider Demographics
NPI:1508990391
Name:NICHOLS, KRISTI LYNNETTE (LPTA)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:LYNNETTE
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4212 CAMPBELLSVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:LYNNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38472-8008
Mailing Address - Country:US
Mailing Address - Phone:931-527-9848
Mailing Address - Fax:
Practice Address - Street 1:1224 TROTWOOD AVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-4802
Practice Address - Country:US
Practice Address - Phone:931-381-1111
Practice Address - Fax:931-490-7038
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2256225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant