Provider Demographics
NPI:1821524042
Name:MARTIN, NICOLE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
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 1:2013 WELLS BRANCH PKWY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78728-6900
Mailing Address - Country:US
Mailing Address - Phone:512-835-6077
Mailing Address - Fax:
Practice Address - Street 1:2013 WELLS BRANCH PKWY
Practice Address - Street 2:SUITE 104
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78728-6900
Practice Address - Country:US
Practice Address - Phone:512-835-6077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-08
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1287159225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist