Individual
MRS. JUDIANNE KING NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPT
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
1371
ID
225100000X
Physical Therapist
Primary
RPT1371
ID
225100000X
Physical Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806941800
—
ID
Enumeration date
11/09/2006
Last updated
07/02/2012
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