Provider Demographics
NPI:1023149911
Name:GRABER, NICOLE M (PT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:M
Last Name:GRABER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11623 ARBOR ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-2981
Mailing Address - Country:US
Mailing Address - Phone:180-033-4191
Mailing Address - Fax:
Practice Address - Street 1:401 CARDINAL AVE
Practice Address - Street 2:
Practice Address - City:ATKINS
Practice Address - State:IA
Practice Address - Zip Code:52206-4701
Practice Address - Country:US
Practice Address - Phone:319-472-6372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03454225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist