Provider Demographics
NPI:1245900356
Name:KAJUT, NICOLE (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:KAJUT
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9218 BALCONES CLUB DR APT 422
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-2750
Mailing Address - Country:US
Mailing Address - Phone:703-282-0580
Mailing Address - Fax:
Practice Address - Street 1:9218 BALCONES CLUB DR APT 422
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-2750
Practice Address - Country:US
Practice Address - Phone:703-282-0580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1349559225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist