Provider Demographics
NPI:1578901302
Name:SABOL, NICOLE THERESA (DPT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:THERESA
Last Name:SABOL
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 1:7 DOCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17842-8910
Mailing Address - Country:US
Mailing Address - Phone:570-837-2123
Mailing Address - Fax:570-837-2185
Practice Address - Street 1:318 NEW BLOOMFIELD RD
Practice Address - Street 2:
Practice Address - City:DUNCANNON
Practice Address - State:PA
Practice Address - Zip Code:17020-9503
Practice Address - Country:US
Practice Address - Phone:717-834-3784
Practice Address - Fax:717-834-3788
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-14
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADAPT003399225100000X
PAPT022744225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA773536OtherMEDICARE
PA1028404780005Medicaid