Provider Demographics
NPI:1710987359
Name:NICHOLS, DONNA SOAVE (PT)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:SOAVE
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 SUMMERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32413-5731
Mailing Address - Country:US
Mailing Address - Phone:850-896-3405
Mailing Address - Fax:
Practice Address - Street 1:7328 THOMAS DR
Practice Address - Street 2:SUITE G
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32408-7500
Practice Address - Country:US
Practice Address - Phone:850-236-3424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT15569225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist