Provider Demographics
NPI:1538635339
Name:LEGACY, NICHOLAS THOMAS (DPT)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:THOMAS
Last Name:LEGACY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 S EBERHART RD
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-2841
Mailing Address - Country:US
Mailing Address - Phone:724-841-6051
Mailing Address - Fax:
Practice Address - Street 1:4225 EXECUTIVE SQ STE 1500
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1487
Practice Address - Country:US
Practice Address - Phone:800-585-1299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-18
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT027130225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist