Provider Demographics
NPI:1942313424
Name:NIGHT, NICHOLAS ELIAS I (LMT/ CST/ AMMP)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:ELIAS
Last Name:NIGHT
Suffix:I
Gender:M
Credentials:LMT/ CST/ AMMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 SHATTUCK ST
Mailing Address - Street 2:
Mailing Address - City:BISBEE
Mailing Address - State:AZ
Mailing Address - Zip Code:85603-1548
Mailing Address - Country:US
Mailing Address - Phone:520-255-1519
Mailing Address - Fax:
Practice Address - Street 1:27 SUBWAY ST.
Practice Address - Street 2:SUITES D & E
Practice Address - City:BISBEE
Practice Address - State:AZ
Practice Address - Zip Code:85603
Practice Address - Country:US
Practice Address - Phone:520-255-1519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06002128A225200000X
FLMA 37184225700000X
WAMA 00007960225700000X
AZMT08447225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA601-628-074OtherUNIFIED BUSINESS IDENTIFI
WA81768OtherLABOR & INDUSTRIES #
WA91-1680461OtherEMPLOYER IDENTIFICATION #
AZ1942313424OtherNPPES NPI
WA121-001-000OtherUS DEPT. OF LABOR PROV. #
WA21257-00OtherNCBTMB LIC. #
AZ451430-10OtherNCBTMB CEU PROVIDER
WAC-2035OtherBLUE CROSS BLUE SHIELD PI
WAMY8742OtherREGENCE INSURANCE ID #
WA601-628-074OtherUNIFIED BUSINESS IDENTIFI