MR. Brian David Nichols, MPT ATC

NPI #1679679088 in Star, Idaho

Provider Information

NPI Number: 1679679088
Entity Type: Individual
Name: MR. Brian David Nichols, MPT ATC
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physical Therapist
Credential: MPT ATC
Enumeration Date: Sep 15, 2006
Last Updated: Jul 2, 2012

Practice Location

Address: 9652 W STATE STREET
City: Star
State: Idaho
ZIP Code: 83669-5858
Phone: (208) 286-0766

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physical Therapist	225100000X	Primary

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