Provider Demographics
NPI:1881027423
Name:STOLLE, NICOLE MARIE (PT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:STOLLE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2840 COMMERCIAL CENTER BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-6411
Mailing Address - Country:US
Mailing Address - Phone:281-693-1063
Mailing Address - Fax:281-693-1081
Practice Address - Street 1:2840 COMMERCIAL CENTER BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-6411
Practice Address - Country:US
Practice Address - Phone:281-693-1063
Practice Address - Fax:281-693-1081
Is Sole Proprietor?:No
Enumeration Date:2013-08-19
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1234663225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist