Provider Demographics
NPI:1760417521
Name:FROST, NICOLE (MSPT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:FROST
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 W 38TH ST
Mailing Address - Street 2:BLDG B3
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1121
Mailing Address - Country:US
Mailing Address - Phone:512-450-0909
Mailing Address - Fax:
Practice Address - Street 1:2765 BEE CAVE RD
Practice Address - Street 2:SUITE 209
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-5640
Practice Address - Country:US
Practice Address - Phone:512-327-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1137875225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist