Provider Demographics
NPI:1790087716
Name:MEHLER, NICOLE MARIE (DPT)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:MARIE
Last Name:MEHLER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:NICOLE
Other - Middle Name:MARIE
Other - Last Name:HALLORAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:3135 HIGHLAND RD STE B
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-4511
Mailing Address - Country:US
Mailing Address - Phone:724-347-2005
Mailing Address - Fax:724-347-4484
Practice Address - Street 1:3135 HIGHLAND RD STE B
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-4511
Practice Address - Country:US
Practice Address - Phone:724-347-2005
Practice Address - Fax:724-347-4484
Is Sole Proprietor?:No
Enumeration Date:2010-11-23
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT017207225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
338788OtherMEDICARE PTAN
338788OtherMEDICARE PTAN