Provider Demographics
NPI:1639134125
Name:ARMBRUST, NICOLE MARTHA (PT, MSPT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARTHA
Last Name:ARMBRUST
Suffix:
Gender:F
Credentials:PT, MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1926 E CITATION LN
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-4709
Mailing Address - Country:US
Mailing Address - Phone:248-229-5600
Mailing Address - Fax:
Practice Address - Street 1:15770 N GREENWAY HAYDEN LOOP
Practice Address - Street 2:SUITE 100
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-1656
Practice Address - Country:US
Practice Address - Phone:480-443-3413
Practice Address - Fax:480-371-2754
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010444225100000X
AZ8222225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ389497Medicaid