Provider Demographics
NPI:1750368544
Name:BOKICH, NICOLE (PT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:BOKICH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:LAPOINTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3497
Mailing Address - Street 2:
Mailing Address - City:STURTEVANT
Mailing Address - State:WI
Mailing Address - Zip Code:53177-0300
Mailing Address - Country:US
Mailing Address - Phone:888-201-1040
Mailing Address - Fax:866-245-8064
Practice Address - Street 1:119 E OGDEN AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3590
Practice Address - Country:US
Practice Address - Phone:630-325-2664
Practice Address - Fax:866-245-8064
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0700062722251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00885657OtherRAILROAD MEDICARE
IL15820003Medicare PIN