Provider Demographics
NPI:1891015731
Name:NICHOLS, SOFIA MARIA (PT)
Entity Type:Individual
Prefix:
First Name:SOFIA
Middle Name:MARIA
Last Name:NICHOLS
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 1:1105 W APACHE ST
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-5408
Mailing Address - Country:US
Mailing Address - Phone:405-476-9401
Mailing Address - Fax:
Practice Address - Street 1:409 FRETZ AVE
Practice Address - Street 2:SUITE D
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73003-5570
Practice Address - Country:US
Practice Address - Phone:405-471-5772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-02
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT1930225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist