Provider Demographics
NPI:1659314722
Name:STRONG, NICOLE CREIGHTON (PT)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:CREIGHTON
Last Name:STRONG
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:PO BOX 38
Mailing Address - Street 2:
Mailing Address - City:HARDWICK
Mailing Address - State:VT
Mailing Address - Zip Code:05843-0038
Mailing Address - Country:US
Mailing Address - Phone:802-472-6622
Mailing Address - Fax:802-472-6633
Practice Address - Street 1:13 PEARL ST
Practice Address - Street 2:
Practice Address - City:HARDWICK
Practice Address - State:VT
Practice Address - Zip Code:05843
Practice Address - Country:US
Practice Address - Phone:802-472-6622
Practice Address - Fax:802-472-6633
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0400002655225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOVN2233Medicaid
VTVN2233Medicare ID - Type Unspecified