Individual
MRS. NICOLE MARIE K
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA - INDIRECT SUP.
Contact information
Practice address
267 FREDERICK ST, HANOVER, PA 17331-3614
(717) 637-8937
Mailing address
2600 COMPASS RD, GLENVIEW, IL 60026-8001
(877) 787-3430
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
TEI003281
PA
Other
Enumeration date
02/14/2017
Last updated
02/25/2020
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