Provider Demographics
NPI:1013331974
Name:NICHOLAS, KYMBERLY ANN (DPT)
Entity Type:Individual
Prefix:
First Name:KYMBERLY
Middle Name:ANN
Last Name:NICHOLAS
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 1:7551 FREDLE DR
Mailing Address - Street 2:
Mailing Address - City:CONCORD TWP
Mailing Address - State:OH
Mailing Address - Zip Code:44077-9406
Mailing Address - Country:US
Mailing Address - Phone:440-350-9595
Mailing Address - Fax:440-357-1905
Practice Address - Street 1:6550 N RIDGE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:MADISON
Practice Address - State:OH
Practice Address - Zip Code:44057-3462
Practice Address - Country:US
Practice Address - Phone:440-428-1944
Practice Address - Fax:440-428-5847
Is Sole Proprietor?:No
Enumeration Date:2014-02-13
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT012182225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist