Provider Demographics
NPI:1811182090
Name:HEWITT, NICOLE (PTA)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:HEWITT
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 1:507 W KENDALL DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:YORKVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60560-1095
Mailing Address - Country:US
Mailing Address - Phone:630-553-0349
Mailing Address - Fax:630-553-0439
Practice Address - Street 1:507 W KENDALL DR
Practice Address - Street 2:SUITE 1
Practice Address - City:YORKVILLE
Practice Address - State:IL
Practice Address - Zip Code:60560-1095
Practice Address - Country:US
Practice Address - Phone:630-553-0349
Practice Address - Fax:630-553-0439
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant