Organization
NICHOLS THERAPY GROUP PC
Active
Other names
NorthStar Physical Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRIAN DAVID NICHOLS MPT (PRESIDENT)
(208) 286-0766
Entity
Organization
Contact information
Practice address
9652 W STATE STREET, STAR, ID 83669-5858
(208) 286-0766
(208) 286-0768
Mailing address
9652 W STATE STREET, STAR, ID 83669-5858
(208) 286-0766
(208) 286-0768
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1136
ID
225100000X
Physical Therapist
RPT1136
ID
225100000X
Physical Therapist
RPT1371
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
80694000
—
ID
Enumeration date
11/09/2006
Last updated
06/29/2012
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