Provider Demographics
NPI:1548250756
Name:BRUMBAUGH, NICOLE R (DPT)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:R
Last Name:BRUMBAUGH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:R
Other - Last Name:TRAUGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:931 E HAVERFORD RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3838
Mailing Address - Country:US
Mailing Address - Phone:610-527-7870
Mailing Address - Fax:610-527-2343
Practice Address - Street 1:931 E HAVERFORD RD STE 201
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3838
Practice Address - Country:US
Practice Address - Phone:610-527-7870
Practice Address - Fax:610-527-2337
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT015937225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist