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Individual

NICOLE ETHRIDGE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PTA

Contact information

Practice address
701 SHADWELL AVE, FLORA, IL 62839-2310
(618) 662-8361
Mailing address
11121 E CANDLEBERRY AVE, EFFINGHAM, IL 62401-7456
(618) 363-8594

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
IL

Other

Enumeration date
07/19/2022
Last updated
07/19/2022
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