Provider Demographics
NPI:1568135291
Name:NICHOL, ERIN (DPT)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:
Last Name:NICHOL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10675 MARANATHA PL
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95949-9261
Mailing Address - Country:US
Mailing Address - Phone:530-913-3645
Mailing Address - Fax:
Practice Address - Street 1:715 MALTMAN DR
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5184
Practice Address - Country:US
Practice Address - Phone:530-272-7306
Practice Address - Fax:530-272-7316
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300478225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist