Individual
NICOLE MARIE POWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT, ATC, LAT
Contact information
Practice address
3600 W BETHEL AVE, MUNCIE, IN 47304-5407
(765) 213-3870
Mailing address
2806 S MOCK AVE, MUNCIE, IN 47302-5446
(260) 729-7152
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
05010696A
IN
225100000X
Physical Therapist
Primary
05010696A
IN
225100000X
Physical Therapist
99048667A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1103842746
ANTHEM PTAN
IN
05
—
300088469
—
IN
Enumeration date
10/25/2011
Last updated
04/18/2024
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