Provider Demographics
NPI:1801307889
Name:NUTTER, DAPHNE NICHOLSON (PTA)
Entity type:Individual
Prefix:
First Name:DAPHNE
Middle Name:NICHOLSON
Last Name:NUTTER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7926 ALABAMA HWY NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-6784
Mailing Address - Country:US
Mailing Address - Phone:678-918-6544
Mailing Address - Fax:
Practice Address - Street 1:7926 ALABAMA HWY NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-6784
Practice Address - Country:US
Practice Address - Phone:678-918-6544
Practice Address - Fax:678-918-6544
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-18
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001168225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant