Provider Demographics
NPI:1841229564
Name:NICHOLS, RODNEY J (PT)
Entity Type:Individual
Prefix:MR
First Name:RODNEY
Middle Name:J
Last Name:NICHOLS
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 1:5935 WASHINGTON AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-2642
Mailing Address - Country:US
Mailing Address - Phone:228-818-2636
Mailing Address - Fax:228-818-2637
Practice Address - Street 1:5935 WASHINGTON AVE
Practice Address - Street 2:SUITE B
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-2642
Practice Address - Country:US
Practice Address - Phone:228-818-2636
Practice Address - Fax:228-818-2637
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT0286225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSPT0286Medicare UPIN