Provider Demographics
NPI:1558393348
Name:LOWER, NICOLE L (MPT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:L
Last Name:LOWER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7626 PARAGON RD
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4049
Mailing Address - Country:US
Mailing Address - Phone:937-424-5607
Mailing Address - Fax:937-425-0032
Practice Address - Street 1:7626 PARAGON RD
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-4049
Practice Address - Country:US
Practice Address - Phone:937-424-5607
Practice Address - Fax:937-425-0032
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-008978225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2668448Medicaid
OH2668448Medicaid
OHLO4023293Medicare PIN