Provider Demographics
NPI:1710208772
Name:HATFIELD, NICOLE M (LPTA)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:M
Last Name:HATFIELD
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7849 COLLIN CT
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1863
Mailing Address - Country:US
Mailing Address - Phone:734-340-3559
Mailing Address - Fax:
Practice Address - Street 1:8380 GEDDES RD
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-9404
Practice Address - Country:US
Practice Address - Phone:734-547-7626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-14
Last Update Date:2011-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06001846A225200000X
MI5502001719225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant