Provider Demographics
NPI:1851870299
Name:MCBRIDE, NICHOLAS THOMAS (DPT)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:THOMAS
Last Name:MCBRIDE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2224 VANSINGEL LAKE DR SW
Mailing Address - Street 2:
Mailing Address - City:BYRON CENTER
Mailing Address - State:MI
Mailing Address - Zip Code:49315-8091
Mailing Address - Country:US
Mailing Address - Phone:616-822-7890
Mailing Address - Fax:
Practice Address - Street 1:6500 BYRON CENTER AVE SW STE 202
Practice Address - Street 2:
Practice Address - City:BYRON CENTER
Practice Address - State:MI
Practice Address - Zip Code:49315-9083
Practice Address - Country:US
Practice Address - Phone:616-249-0750
Practice Address - Fax:616-249-0794
Is Sole Proprietor?:No
Enumeration Date:2018-08-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501016868208100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation