Provider Demographics
NPI:1336795889
Name:ROTHWELL, NOLAN (DPT)
Entity Type:Individual
Prefix:
First Name:NOLAN
Middle Name:
Last Name:ROTHWELL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1681 WASHINGTON ST STE 1
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-7951
Mailing Address - Country:US
Mailing Address - Phone:339-987-4856
Mailing Address - Fax:339-987-4858
Practice Address - Street 1:1681 WASHINGTON ST STE 1
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-7951
Practice Address - Country:US
Practice Address - Phone:339-987-4856
Practice Address - Fax:339-987-4858
Is Sole Proprietor?:No
Enumeration Date:2019-08-12
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA24480225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA24480OtherMA ALLIED HEALTH