Provider Demographics
NPI:1295112993
Name:LICHTENWALNER, NICOLE (MS, LAT, ATC, CEAS I)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:LICHTENWALNER
Suffix:
Gender:F
Credentials:MS, LAT, ATC, CEAS I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 CAMELOT LN
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-7721
Mailing Address - Country:US
Mailing Address - Phone:561-214-0799
Mailing Address - Fax:
Practice Address - Street 1:701 DRIVER DR
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22807-1002
Practice Address - Country:US
Practice Address - Phone:540-568-8764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer