Provider Demographics
NPI:1568613750
Name:SPAULDING, NICOLE L (PT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:L
Last Name:SPAULDING
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2680 S VAL VISTA DR STE 106
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-1606
Mailing Address - Country:US
Mailing Address - Phone:480-892-7986
Mailing Address - Fax:
Practice Address - Street 1:2680 S VAL VISTA DR STE 106
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-1606
Practice Address - Country:US
Practice Address - Phone:480-892-7986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-06
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8229225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ393627Medicaid
AZ393627Medicaid