Provider Demographics
NPI:1740890516
Name:NEWQUIST, NICHOLAS DANIEL (DPT)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:DANIEL
Last Name:NEWQUIST
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 1:8275 E BELL RD APT 1122
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-1030
Mailing Address - Country:US
Mailing Address - Phone:847-848-4070
Mailing Address - Fax:
Practice Address - Street 1:5410 E HIGH ST STE 107
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85054-5457
Practice Address - Country:US
Practice Address - Phone:602-404-8012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-05
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31375225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist