Provider Demographics
NPI:1003899782
Name:COLDICOTT, NANCY LEIGH (PT)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:LEIGH
Last Name:COLDICOTT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:NANCY
Other - Middle Name:LEIGH
Other - Last Name:FIELMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 4649
Mailing Address - Street 2:
Mailing Address - City:LAGO VISTA
Mailing Address - State:TX
Mailing Address - Zip Code:78645-0054
Mailing Address - Country:US
Mailing Address - Phone:512-267-5400
Mailing Address - Fax:512-267-5700
Practice Address - Street 1:5802 THUNDERBIRD ST
Practice Address - Street 2:SUITE A
Practice Address - City:LAGO VISTA
Practice Address - State:TX
Practice Address - Zip Code:78645-5887
Practice Address - Country:US
Practice Address - Phone:512-267-5400
Practice Address - Fax:512-267-5700
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-27
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1134674225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX659590OtherBCBS
TX201463103Medicaid
TX201463102Medicaid
TXP22542Medicare UPIN