Provider Demographics
NPI:1649383746
Name:KING, NICHOLE R (DPT)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:R
Last Name:KING
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
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Mailing Address - Street 1:860 OMNI BLVD
Mailing Address - Street 2:STE 303
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4434
Mailing Address - Country:US
Mailing Address - Phone:757-232-8769
Mailing Address - Fax:757-232-8875
Practice Address - Street 1:860 OMNI BLVD
Practice Address - Street 2:STE 103
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4434
Practice Address - Country:US
Practice Address - Phone:757-223-9403
Practice Address - Fax:757-223-5546
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2016-03-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA2305204754225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist