Provider Demographics
NPI:1013101245
Name:NICHOLSON, SHEILA M (PT, MS)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:M
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:PT, MS
Other - Prefix:
Other - First Name:SHEILA
Other - Middle Name:M
Other - Last Name:MCCOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:518 W EDWARDS ST APT A
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-1920
Mailing Address - Country:US
Mailing Address - Phone:217-638-1646
Mailing Address - Fax:
Practice Address - Street 1:1700 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-6420
Practice Address - Country:US
Practice Address - Phone:217-619-0667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-30
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.007543225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL070-007543OtherSTATE LICENSE