Provider Demographics
NPI:1659828622
Name:REX, NICHOLAS THOMAS (DPT, CSCS)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:THOMAS
Last Name:REX
Suffix:
Gender:M
Credentials:DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:I-16 ST JOSEPH-ROSENDAHL
Mailing Address - Street 2:
Mailing Address - City:ST THOMAS
Mailing Address - State:USVI
Mailing Address - Zip Code:00802
Mailing Address - Country:UM
Mailing Address - Phone:912-674-0844
Mailing Address - Fax:340-715-4678
Practice Address - Street 1:1001 ESTATE ROSS SUITE 6
Practice Address - Street 2:
Practice Address - City:ST THOMAS
Practice Address - State:USVI
Practice Address - Zip Code:00802
Practice Address - Country:UM
Practice Address - Phone:340-779-4678
Practice Address - Fax:340-715-4678
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI2182251X0800X
GAPT0110022251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic