Provider Demographics
NPI:1801308895
Name:GAITHER, NICOLE (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:GAITHER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:891 ELKRIDGE LANDING RD STE 150
Mailing Address - Street 2:
Mailing Address - City:LINTHICUM
Mailing Address - State:MD
Mailing Address - Zip Code:21090-2934
Mailing Address - Country:US
Mailing Address - Phone:443-410-3132
Mailing Address - Fax:410-487-6145
Practice Address - Street 1:891 ELKRIDGE LANDING RD STE 150
Practice Address - Street 2:
Practice Address - City:LINTHICUM
Practice Address - State:MD
Practice Address - Zip Code:21090-2934
Practice Address - Country:US
Practice Address - Phone:443-410-3132
Practice Address - Fax:410-487-6145
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-30
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17270225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist