Provider Demographics
NPI:1740390798
Name:HARDENBROOK, NICHOLE (CPTA)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:
Last Name:HARDENBROOK
Suffix:
Gender:F
Credentials:CPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 831
Mailing Address - Street 2:
Mailing Address - City:MADILL
Mailing Address - State:OK
Mailing Address - Zip Code:73446-0831
Mailing Address - Country:US
Mailing Address - Phone:580-795-3301
Mailing Address - Fax:580-795-7307
Practice Address - Street 1:849 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HOWARD
Practice Address - State:KS
Practice Address - Zip Code:67349-9418
Practice Address - Country:US
Practice Address - Phone:620-374-2708
Practice Address - Fax:620-374-2098
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-01642225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant