Provider Demographics
NPI:1679146864
Name:SIKKINK, NICOLE KATHRYN (DPT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:KATHRYN
Last Name:SIKKINK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 N JAMES AVE
Mailing Address - Street 2:
Mailing Address - City:TEA
Mailing Address - State:SD
Mailing Address - Zip Code:57064-2246
Mailing Address - Country:US
Mailing Address - Phone:605-659-5902
Mailing Address - Fax:
Practice Address - Street 1:1020 W 18TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-4707
Practice Address - Country:US
Practice Address - Phone:605-444-9700
Practice Address - Fax:605-444-9701
Is Sole Proprietor?:No
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD2135225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist