Provider Demographics
NPI:1942534441
Name:CICERO, NICHOLAS IV (DPT)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:CICERO
Suffix:IV
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3797 BIGMAN LANE
Mailing Address - Street 2:
Mailing Address - City:TORBERT
Mailing Address - State:LA
Mailing Address - Zip Code:70762
Mailing Address - Country:US
Mailing Address - Phone:225-939-3923
Mailing Address - Fax:
Practice Address - Street 1:59295 RIVER WEST DRIVE
Practice Address - Street 2:
Practice Address - City:PLAQUEMINE
Practice Address - State:LA
Practice Address - Zip Code:70764
Practice Address - Country:US
Practice Address - Phone:225-687-2066
Practice Address - Fax:225-687-2067
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-30
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07694225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist