Provider Demographics
NPI:1255398103
Name:DAWSON, NICOLE THERESE (PT, PHD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:THERESE
Last Name:DAWSON
Suffix:
Gender:F
Credentials:PT, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14296 RENSSELAER RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32826-3558
Mailing Address - Country:US
Mailing Address - Phone:330-620-6365
Mailing Address - Fax:
Practice Address - Street 1:IMOVE LAB AT UCF
Practice Address - Street 2:3280 PROGRESS DRIVE #722
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32826
Practice Address - Country:US
Practice Address - Phone:330-620-6365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH10134225100000X
FL30404225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist