Provider Demographics
NPI:1699351981
Name:ANDERSON, NICHOLAS W (DPT)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:W
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23811 CHAGRIN BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5555
Mailing Address - Country:US
Mailing Address - Phone:216-682-0413
Mailing Address - Fax:216-682-0417
Practice Address - Street 1:23811 CHAGRIN BLVD STE 120
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5555
Practice Address - Country:US
Practice Address - Phone:216-682-0413
Practice Address - Fax:316-682-0417
Is Sole Proprietor?:No
Enumeration Date:2021-03-18
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT018492225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist