Provider Demographics
NPI:1659099539
Name:TINSMAN, NICOLE GISELE (PTA)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:GISELE
Last Name:TINSMAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:GISELE
Other - Last Name:LEGARE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:152 LINDEN DR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2818
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:152 LINDEN DR
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2818
Practice Address - Country:US
Practice Address - Phone:540-667-9252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-17
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306605177225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant