Provider Demographics
NPI:1457936783
Name:NICOLAS, REDA (DPT)
Entity Type:Individual
Prefix:
First Name:REDA
Middle Name:
Last Name:NICOLAS
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 1:22924 CHESTERVIEW LOOP APT 105
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34639-5346
Mailing Address - Country:US
Mailing Address - Phone:813-943-3052
Mailing Address - Fax:
Practice Address - Street 1:38130 PRETTY POND RD
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33540-1419
Practice Address - Country:US
Practice Address - Phone:813-778-0905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT25194225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist