Provider Demographics
NPI:1649332933
Name:WILLIAMS, NICHOLE L (DPT)
Entity type:Individual
Prefix:
First Name:NICHOLE
Middle Name:L
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:NICHOLE
Other - Middle Name:
Other - Last Name:WHITFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:5301 PROVIDENCE RD
Mailing Address - Street 2:SUITE 80
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-4128
Mailing Address - Country:US
Mailing Address - Phone:757-467-1900
Mailing Address - Fax:757-489-7900
Practice Address - Street 1:3216 MEADOWBROOK LN
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-5440
Practice Address - Country:US
Practice Address - Phone:757-651-1137
Practice Address - Fax:757-606-2520
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305204900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist