Provider Demographics
NPI:1881638278
Name:LLOYD, NICHOLLE (PT)
Entity Type:Individual
Prefix:
First Name:NICHOLLE
Middle Name:
Last Name:LLOYD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 HARGROVE RD E
Mailing Address - Street 2:STE E
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401-3791
Mailing Address - Country:US
Mailing Address - Phone:205-523-9000
Mailing Address - Fax:205-523-9001
Practice Address - Street 1:501 HARGROVE RD E
Practice Address - Street 2:STE E
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-3791
Practice Address - Country:US
Practice Address - Phone:205-523-9000
Practice Address - Fax:205-523-9001
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH3952225100000X
SC6819225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL890012590Medicaid