Provider Demographics
NPI:1558376970
Name:BATSON, NICHOLAS A (PT, DPT)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:A
Last Name:BATSON
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5809 ROCKY BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:SIGNAL MOUNTAIN
Mailing Address - State:TN
Mailing Address - Zip Code:37377-1338
Mailing Address - Country:US
Mailing Address - Phone:847-254-1708
Mailing Address - Fax:423-269-8746
Practice Address - Street 1:313 FREEMAN STREET
Practice Address - Street 2:
Practice Address - City:GENOA CITY
Practice Address - State:WI
Practice Address - Zip Code:53128
Practice Address - Country:US
Practice Address - Phone:262-279-8000
Practice Address - Fax:423-269-8764
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9814-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100015187Medicaid