Provider Demographics
NPI:1942383229
Name:POWELL, NICOLE L (DPT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:L
Last Name:POWELL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 E 14TH ST STE 40
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-3240
Mailing Address - Country:US
Mailing Address - Phone:402-462-2665
Mailing Address - Fax:
Practice Address - Street 1:223 E 14TH ST
Practice Address - Street 2:STE 40
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-3200
Practice Address - Country:US
Practice Address - Phone:402-462-2665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2216225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE39530OtherBLUE CROSS
NE39530OtherBLUE CROSS