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Individual

NICOLE MARIE IVANOV

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DPT

Contact information

Practice address
7209 N SHADELAND AVE, INDIANAPOLIS, IN 46250-2021
(219) 671-0087
Mailing address
4764 CLIFTY FALLS CT, INDIANAPOLIS, IN 46239-9760
(219) 671-0087

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
99051811A
IN

Other

Enumeration date
05/30/2012
Last updated
03/09/2022
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