Provider Demographics
NPI:1770712853
Name:NICHOLS, PATRICIA R (RPT, DPT)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:R
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:RPT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2455 OAK GROVE CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-9513
Mailing Address - Country:US
Mailing Address - Phone:334-669-5757
Mailing Address - Fax:
Practice Address - Street 1:2455 OAK GROVE CHURCH RD
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-9513
Practice Address - Country:US
Practice Address - Phone:770-834-1737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1595225100000X
GAPT012279225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist