Provider Demographics
NPI:1568757839
Name:MAR, NICOLLE YUKIE (PT, DPT, CSCS)
Entity Type:Individual
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First Name:NICOLLE
Middle Name:YUKIE
Last Name:MAR
Suffix:
Gender:F
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8501 E ALAMEDA AVE
Mailing Address - Street 2:UNIT 838
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-6891
Mailing Address - Country:US
Mailing Address - Phone:310-418-9040
Mailing Address - Fax:
Practice Address - Street 1:2149 S HOLLY ST
Practice Address - Street 2:SUITE 200
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-5601
Practice Address - Country:US
Practice Address - Phone:303-477-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
COPTL-11240225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist