Provider Demographics
NPI:1972721694
Name:NICHOLS, BETH ANNE (PTA, ATC)
Entity Type:Individual
Prefix:
First Name:BETH ANNE
Middle Name:
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:PTA, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:932 W 9TH ST
Mailing Address - Street 2:APT. 2
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16502-1129
Mailing Address - Country:US
Mailing Address - Phone:814-453-3469
Mailing Address - Fax:
Practice Address - Street 1:8155 OLIVER RD
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509-4683
Practice Address - Country:US
Practice Address - Phone:814-866-5930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE005043L225200000X
PART001659A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer