Provider Demographics
NPI:1477896181
Name:NICHOLSON, JULIE BETH (LPTA)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:BETH
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11892 CEDARWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35475-4801
Mailing Address - Country:US
Mailing Address - Phone:205-765-3503
Mailing Address - Fax:
Practice Address - Street 1:400 MCFARLAND BLVD STE F
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35476-3371
Practice Address - Country:US
Practice Address - Phone:205-333-5351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-01
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTA 5455225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant