Individual
SAMUEL MARTIN NICHOLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
1630 BEAVERCREEK RD, OREGON CITY, OR 97045-4156
(503) 607-0047
(503) 607-0051
Mailing address
PO BOX 578, TROUTDALE, OR 97060-0578
(503) 489-1174
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
63810
OR
225100000X
Physical Therapist
CP0003840T
WA
Other
Enumeration date
12/07/2020
Last updated
12/07/2020
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