Provider Demographics
NPI:1609204775
Name:CROSSER, NIKKI (DPT, LAT ATC)
Entity Type:Individual
Prefix:DR
First Name:NIKKI
Middle Name:
Last Name:CROSSER
Suffix:
Gender:F
Credentials:DPT, LAT ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 MAIN ST. SOUTH
Mailing Address - Street 2:
Mailing Address - City:MCKENZIE
Mailing Address - State:TN
Mailing Address - Zip Code:38202
Mailing Address - Country:US
Mailing Address - Phone:731-393-0504
Mailing Address - Fax:731-393-0508
Practice Address - Street 1:103 MAIN ST S
Practice Address - Street 2:
Practice Address - City:MC KENZIE
Practice Address - State:TN
Practice Address - Zip Code:38201-2200
Practice Address - Country:US
Practice Address - Phone:731-393-0504
Practice Address - Fax:731-393-0508
Is Sole Proprietor?:No
Enumeration Date:2013-10-28
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8750225100000X
KY6207225100000X
TN16402255A2300X
KY10432255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer