Provider Demographics
NPI:1760094429
Name:MERCER, NICHOLAS EVERETT (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:EVERETT
Last Name:MERCER
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 N GOLDENROD RD STE 1
Mailing Address - Street 2:
Mailing Address - City:AZALEA PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32807-6205
Mailing Address - Country:US
Mailing Address - Phone:407-536-6043
Mailing Address - Fax:
Practice Address - Street 1:875 N GOLDENROD RD STE 1
Practice Address - Street 2:
Practice Address - City:AZALEA PARK
Practice Address - State:FL
Practice Address - Zip Code:32807-6205
Practice Address - Country:US
Practice Address - Phone:407-536-6043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-23
Last Update Date:2020-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL36109225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist