Provider Demographics
NPI:1548496789
Name:NICHOLS, HEATHER HILL (DPT)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:HILL
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1322 ELTON RD
Mailing Address - Street 2:SUITE I
Mailing Address - City:JENNINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70546-4100
Mailing Address - Country:US
Mailing Address - Phone:337-824-5488
Mailing Address - Fax:337-824-5494
Practice Address - Street 1:1322 ELTON RD
Practice Address - Street 2:SUITE I
Practice Address - City:JENNINGS
Practice Address - State:LA
Practice Address - Zip Code:70546-4100
Practice Address - Country:US
Practice Address - Phone:337-824-5488
Practice Address - Fax:337-824-5494
Is Sole Proprietor?:No
Enumeration Date:2009-06-02
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA06627225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist