Provider Demographics
NPI:1780616839
Name:NICKLIN-TOBIN, ALLISON C (PT DPT MTC)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:C
Last Name:NICKLIN-TOBIN
Suffix:
Gender:F
Credentials:PT DPT MTC
Other - Prefix:DR
Other - First Name:ALLISON
Other - Middle Name:C
Other - Last Name:NICKLIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT MTC
Mailing Address - Street 1:155 PRINTERS PKWY
Mailing Address - Street 2:SUITE 125
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-6100
Mailing Address - Country:US
Mailing Address - Phone:719-635-8622
Mailing Address - Fax:719-635-8619
Practice Address - Street 1:155 PRINTERS PARKWAY
Practice Address - Street 2:SUITE 125
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910
Practice Address - Country:US
Practice Address - Phone:719-635-8622
Practice Address - Fax:719-635-8619
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5237DPT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO803713Medicare UPIN