Provider Demographics
NPI:1558571042
Name:DAVIS-PIERCEY, NICHALLE D (PT)
Entity Type:Individual
Prefix:
First Name:NICHALLE
Middle Name:D
Last Name:DAVIS-PIERCEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:NICHALLE
Other - Middle Name:D
Other - Last Name:DAVIS-PIERCEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:11620 MILL HOLLOW CT
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73131-7522
Mailing Address - Country:US
Mailing Address - Phone:405-607-6097
Mailing Address - Fax:
Practice Address - Street 1:6801 N CLASSEN BLVD
Practice Address - Street 2:STE B
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-7205
Practice Address - Country:US
Practice Address - Phone:405-810-2902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT2118225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist