Individual
KOURTNEY NICKELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.A.
Contact information
Practice address
118 MEDICAL DR, CARMEL, IN 46032-2923
(317) 573-1037
Mailing address
4746 E HIGHWAY 36, MOORELAND, IN 47360
(765) 571-2501
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
06005451A
IN
Other
Enumeration date
02/13/2017
Last updated
02/13/2017
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