Provider Demographics
NPI:1205114105
Name:SANDRIDGE, NICOLE B (DPT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:B
Last Name:SANDRIDGE
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 1:13000 RIVERS BEND BLVD
Mailing Address - Street 2:STE D
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23836-8632
Mailing Address - Country:US
Mailing Address - Phone:804-571-5106
Mailing Address - Fax:804-530-1857
Practice Address - Street 1:13048 RIVERS BEND RD
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23836-2564
Practice Address - Country:US
Practice Address - Phone:804-523-0333
Practice Address - Fax:804-530-9998
Is Sole Proprietor?:No
Enumeration Date:2011-07-26
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305206997225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist