Provider Demographics
NPI:1710166798
Name:WINDSOR, NICOLE D (MPT, DPT, FAAOMPT)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:D
Last Name:WINDSOR
Suffix:
Gender:F
Credentials:MPT, DPT, FAAOMPT
Other - Prefix:DR
Other - First Name:NICOLE
Other - Middle Name:D
Other - Last Name:MCMINIMY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT, DPT, FAAOMPT
Mailing Address - Street 1:11970 S BLACKBOB RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-2022
Mailing Address - Country:US
Mailing Address - Phone:913-393-0992
Mailing Address - Fax:913-393-0169
Practice Address - Street 1:11970 S BLACKBOB RD
Practice Address - Street 2:SUITE 100
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-2022
Practice Address - Country:US
Practice Address - Phone:913-393-0992
Practice Address - Fax:913-393-0169
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-26
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1103466225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSKA182001OtherMEDICARE PTAN