Provider Demographics
NPI:1821709007
Name:CHALA, NICHOLE SHAN (PT)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:SHAN
Last Name:CHALA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:NICHOLE
Other - Middle Name:SHAN
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:713 PINE VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75901-7498
Mailing Address - Country:US
Mailing Address - Phone:936-208-7003
Mailing Address - Fax:
Practice Address - Street 1:521 N BRENTWOOD
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-7124
Practice Address - Country:US
Practice Address - Phone:936-632-2639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-08
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1201380225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist