Provider Demographics
NPI:1952513418
Name:HALL, NIKOLE FICHTER (PT)
Entity Type:Individual
Prefix:
First Name:NIKOLE
Middle Name:FICHTER
Last Name:HALL
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 1:1539 SE 12TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-1433
Mailing Address - Country:US
Mailing Address - Phone:954-873-5864
Mailing Address - Fax:954-524-1828
Practice Address - Street 1:959 E COMMERCIAL BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33334-3297
Practice Address - Country:US
Practice Address - Phone:954-873-5864
Practice Address - Fax:954-524-1828
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 19813225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU4755Medicare ID - Type Unspecified