Individual
BRIAN NICHOLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
758 STATE ROUTE 18, EAST BRUNSWICK, NJ 08816-4910
(732) 254-0090
Mailing address
758 ROUTE 18, EAST BRUNSWICK, NJ 08816-4910
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
40QB00368000
NJ
Other
Enumeration date
08/13/2021
Last updated
08/13/2021
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