Provider Demographics
NPI:1710212469
Name:NICHOLL, JUDY A (LPTA)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:A
Last Name:NICHOLL
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 1:5200 MARYMOUNT VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-2973
Mailing Address - Country:US
Mailing Address - Phone:216-332-1100
Mailing Address - Fax:
Practice Address - Street 1:5200 MARYMOUNT VILLAGE DR
Practice Address - Street 2:
Practice Address - City:GARFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44125-2973
Practice Address - Country:US
Practice Address - Phone:216-332-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-14
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA-01632225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant