Provider Demographics
NPI:1669818407
Name:STONE, NIKKI (PTA)
Entity Type:Individual
Prefix:
First Name:NIKKI
Middle Name:
Last Name:STONE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8230 PEPPERVINE CT
Mailing Address - Street 2:APT/SUITE
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77385-1101
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8230 PEPPERVINE CT
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77385-1101
Practice Address - Country:US
Practice Address - Phone:662-312-4270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-20
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2087843225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant