Provider Demographics
NPI:1881044063
Name:TUBBS, NICOLE
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:TUBBS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 NORTH WASHINGTON BLVD.
Mailing Address - Street 2:PHYSICAL THERAPY
Mailing Address - City:NORTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84414-7367
Mailing Address - Country:US
Mailing Address - Phone:801-786-7700
Mailing Address - Fax:
Practice Address - Street 1:2400 NORTH WASHINGTON BLVD.
Practice Address - Street 2:PHYSICAL THERAPY
Practice Address - City:NORTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84414-7367
Practice Address - Country:US
Practice Address - Phone:801-786-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-17
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9324767-2402225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant