Individual
TAMARA A NICKSIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
8259 WICKER AVE, SAINT JOHN, IN 46373-8878
(219) 365-6560
(219) 365-6561
Mailing address
2203 WYNNEWOOD DR, VALPARAISO, IN 46385-2828
(219) 789-5865
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05002433A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05002433A
LPT
IN
Enumeration date
07/12/2007
Last updated
11/08/2018
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