Provider Demographics
NPI:1952665721
Name:NICHOLSON, TAMARA GERRY (DPT)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:GERRY
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4440 N 36TH ST STE 240
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-3592
Mailing Address - Country:US
Mailing Address - Phone:602-956-4040
Mailing Address - Fax:602-956-4011
Practice Address - Street 1:4440 N 36TH ST STE 240
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-3592
Practice Address - Country:US
Practice Address - Phone:602-956-4040
Practice Address - Fax:602-956-4011
Is Sole Proprietor?:No
Enumeration Date:2012-06-27
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ98192251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports