Provider Demographics
NPI:1629704986
Name:NICKLE, DEBRA SUE (PT)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:SUE
Last Name:NICKLE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 REMUDA
Mailing Address - Street 2:
Mailing Address - City:LIBERTY HILL
Mailing Address - State:TX
Mailing Address - Zip Code:78642-4551
Mailing Address - Country:US
Mailing Address - Phone:512-423-6011
Mailing Address - Fax:
Practice Address - Street 1:216 REMUDA
Practice Address - Street 2:
Practice Address - City:LIBERTY HILL
Practice Address - State:TX
Practice Address - Zip Code:78642-4551
Practice Address - Country:US
Practice Address - Phone:512-423-6011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1034460225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist