Provider Demographics
NPI:1922209584
Name:NICHOLSON, AMBER JOY (PTA)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:JOY
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3370 LINDNER LN
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-8678
Mailing Address - Country:US
Mailing Address - Phone:843-216-1713
Mailing Address - Fax:
Practice Address - Street 1:3400 SALTERBECK CT
Practice Address - Street 2:SUITE 102
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-7118
Practice Address - Country:US
Practice Address - Phone:843-971-3373
Practice Address - Fax:843-971-2806
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC598225200000X
SC2623225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Not Answered225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist