Provider Demographics
NPI:1730893793
Name:BIRNHAK, NICOLE (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:BIRNHAK
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 HIGH PINE TRL
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29617-1337
Mailing Address - Country:US
Mailing Address - Phone:336-324-0327
Mailing Address - Fax:
Practice Address - Street 1:104 S POINSETT HWY STE C2
Practice Address - Street 2:
Practice Address - City:TRAVELERS REST
Practice Address - State:SC
Practice Address - Zip Code:29690-1843
Practice Address - Country:US
Practice Address - Phone:864-610-5101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12764225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist