Individual
THERESA NICHOLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
2107 N DECATUR RD UNIT 506, DECATUR, GA 30033-5305
(470) 831-4049
(770) 626-0089
Mailing address
2107 N DECATUR RD UNIT 506, DECATUR, GA 30033-5305
(470) 831-4049
(770) 626-0089
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
PT015743
GA
2251X0800X
Orthopedic Physical Therapist
PT015743
GA
Other
Enumeration date
01/24/2022
Last updated
05/28/2025
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