Individual
TODD NICHOLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
315 W 5TH ST, STORM LAKE, IA 50588-1743
(712) 732-7725
(712) 732-5153
Mailing address
913 ANGIER DR, STORM LAKE, IA 50588-2817
(712) 732-7725
(712) 732-5153
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2144
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11024
WELLMARK BCBS OF IOWA
IA
Enumeration date
02/02/2007
Last updated
07/08/2007
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