Provider Demographics
NPI:1760902779
Name:NICHOLAS, ROSLYN CREWS (PT)
Entity Type:Individual
Prefix:
First Name:ROSLYN
Middle Name:CREWS
Last Name:NICHOLAS
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 1:5505 CREEDMOOR RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-6352
Mailing Address - Country:US
Mailing Address - Phone:919-785-9090
Mailing Address - Fax:
Practice Address - Street 1:5505 CREEDMORE RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-6352
Practice Address - Country:US
Practice Address - Phone:919-785-9090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP3555225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist