Provider Demographics
NPI:1831320449
Name:IMHOFF, NIKKI N (DPT)
Entity Type:Individual
Prefix:
First Name:NIKKI
Middle Name:N
Last Name:IMHOFF
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:NIKKI
Other - Middle Name:NOELLE
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1105 18TH ST
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-2421
Mailing Address - Country:US
Mailing Address - Phone:814-944-6535
Mailing Address - Fax:814-944-6545
Practice Address - Street 1:1105 18TH ST
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-2421
Practice Address - Country:US
Practice Address - Phone:814-944-6535
Practice Address - Fax:814-944-6545
Is Sole Proprietor?:No
Enumeration Date:2009-07-30
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT020082225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist