Provider Demographics
NPI:1568718252
Name:TESTIN, NICHOLAS D (DPT)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:D
Last Name:TESTIN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1137 N EOLA RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60502-7096
Mailing Address - Country:US
Mailing Address - Phone:630-236-6698
Mailing Address - Fax:
Practice Address - Street 1:1137 N EOLA RD
Practice Address - Street 2:SUITE 106
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60502-7096
Practice Address - Country:US
Practice Address - Phone:630-236-6698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-019206225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist