Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 21293 | MA |
NPI | 1013316629 |
---|---|
Provider Name | Dr. Elise Nichols |
First Address | Pittsfield, MA 01201-4037 |
Second Address | Pittsfield, MA 01201-4037 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2014 |
Last Update Date | 19/08/2014 |