Provider Demographics
NPI:1598494569
Name:RICE, NICKOLAS ANDREW (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:NICKOLAS
Middle Name:ANDREW
Last Name:RICE
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3420 E GLENHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-7879
Mailing Address - Country:US
Mailing Address - Phone:480-330-0291
Mailing Address - Fax:
Practice Address - Street 1:655 S DOBSON RD STE B-111
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5667
Practice Address - Country:US
Practice Address - Phone:480-732-0099
Practice Address - Fax:480-732-7457
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-06
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0018334225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist