Provider Demographics
NPI:1649412651
Name:STANN, NICOLA GEARING (PT)
Entity Type:Individual
Prefix:MRS
First Name:NICOLA
Middle Name:GEARING
Last Name:STANN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:440 DUNHILL VIEW CT
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-4648
Mailing Address - Country:US
Mailing Address - Phone:404-376-9994
Mailing Address - Fax:770-962-4045
Practice Address - Street 1:2576 LAWRENCEVILLE SUWANEE RD
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-7290
Practice Address - Country:US
Practice Address - Phone:770-670-6558
Practice Address - Fax:770-962-4045
Is Sole Proprietor?:No
Enumeration Date:2009-04-06
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT008845225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist