Provider Demographics
NPI:1144362583
Name:RICE, NICHOLA (PTA)
Entity type:Individual
Prefix:
First Name:NICHOLA
Middle Name:
Last Name:RICE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4519 N GARFIELD ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79705-3415
Mailing Address - Country:US
Mailing Address - Phone:432-570-8782
Mailing Address - Fax:
Practice Address - Street 1:4519 N GARFIELD ST
Practice Address - Street 2:SUITE 5
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79705-3415
Practice Address - Country:US
Practice Address - Phone:432-570-8782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2056020225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45-6646Medicare ID - Type Unspecified