Provider Demographics
NPI:1023997483
Name:NICHOL, MADELINE SARAH (PT, DPT)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:SARAH
Last Name:NICHOL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 CUMING ST APT 514
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68102-4737
Mailing Address - Country:US
Mailing Address - Phone:847-302-2009
Mailing Address - Fax:
Practice Address - Street 1:310 E GOLD COAST RD STE 113
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-4857
Practice Address - Country:US
Practice Address - Phone:402-609-1750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-29
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4803225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
568946544OtherBCBS
5874OtherHEALTH PARTNERS
DC236Medicaid