Provider Demographics
NPI:1831119874
Name:NICHOLSON, RICHARD KEVIN (PT)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:KEVIN
Last Name:NICHOLSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7603 COUNTRYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79119-6490
Mailing Address - Country:US
Mailing Address - Phone:806-418-4363
Mailing Address - Fax:
Practice Address - Street 1:6010 AMARILLO BLVD WEST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1990
Practice Address - Country:US
Practice Address - Phone:806-355-9703
Practice Address - Fax:806-356-3733
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
TX1092922225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist