Provider Demographics
NPI:1770607533
Name:PUMP, NICOLE D (DPT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:D
Last Name:PUMP
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:D
Other - Last Name:WELLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:12531 REGENCY PKWY
Mailing Address - Street 2:
Mailing Address - City:HUNTLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60142-6500
Mailing Address - Country:US
Mailing Address - Phone:847-659-1000
Mailing Address - Fax:847-659-1012
Practice Address - Street 1:12531 REGENCY PKWY
Practice Address - Street 2:
Practice Address - City:HUNTLEY
Practice Address - State:IL
Practice Address - Zip Code:60142-6500
Practice Address - Country:US
Practice Address - Phone:847-659-1000
Practice Address - Fax:847-659-1012
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070015618225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILRO1115Medicare UPIN