Provider Demographics
NPI:1720393002
Name:FLOUNDERS, NICOLE (DPT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:FLOUNDERS
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 1:300 EDWARDSVILLE RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:TROY
Mailing Address - State:IL
Mailing Address - Zip Code:62294-1304
Mailing Address - Country:US
Mailing Address - Phone:618-667-3900
Mailing Address - Fax:618-667-3910
Practice Address - Street 1:300 EDWARDSVILLE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:TROY
Practice Address - State:IL
Practice Address - Zip Code:62294-1304
Practice Address - Country:US
Practice Address - Phone:618-667-3900
Practice Address - Fax:618-667-3910
Is Sole Proprietor?:No
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.017971225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist