Provider Demographics
NPI:1578867511
Name:NICHOLSON, KAREN CHRISTINE (PTA)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:CHRISTINE
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3184 61ST LN N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-1748
Mailing Address - Country:US
Mailing Address - Phone:727-343-8555
Mailing Address - Fax:
Practice Address - Street 1:3184 61ST LN N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-1748
Practice Address - Country:US
Practice Address - Phone:727-343-8555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-05
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA1145225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant