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Individual

NICOLE PODGURSKI

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PTA

Contact information

Practice address
13575 W MCDOWELL RD, GOODYEAR, AZ 85395-2604
(602) 831-8454
Mailing address
13575 W MCDOWELL RD, GOODYEAR, AZ 85395-2604
(602) 831-8454

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
014365
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
014365
AZ
Enumeration date
12/14/2021
Last updated
01/05/2022
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