Individual
NICOLE HENLINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
10443 ILLINOIS RD, FORT WAYNE, IN 46814-9181
(260) 625-5005
Mailing address
10443 ILLINOIS RD, FORT WAYNE, IN 46814-9181
(260) 625-5005
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
06002875A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06002875A
LICENSE
IN
Enumeration date
10/30/2007
Last updated
10/30/2007
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