Provider Demographics
NPI:1780093518
Name:NICHOLS, BENJAMIN SCOTT (PT)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:SCOTT
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6469 E ANDREWS AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-8924
Mailing Address - Country:US
Mailing Address - Phone:209-814-7605
Mailing Address - Fax:
Practice Address - Street 1:6469 E ANDREWS AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-8924
Practice Address - Country:US
Practice Address - Phone:209-814-7605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-06
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist