Nichols, Brian David

Nichols, Brian David is an individual health care provider with primary practice located at 9652 W State Street , Star ID 83669-5858. He recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, which is considered as his primary health care specialty. Nichols, Brian David can be contacted via phone (208) 286-0766.

Contact Information

Primary practice address
9652 W State Street Star ID 83669-5858
Phone: (208) 286-0766
Fax: (208) 286-0768
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist 225100000X 1136 Idaho
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist 225100000X RPT1136 Idaho

Profile Details

NPI number 1679679088
LBN Legal business name Nichols, Brian David
Credentials MPT ATC
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 15th, 2006
Last updated Jul 2nd, 2012 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1679679088 NPPES
Idaho Other 000010147595 REGENCE BLUE SHIELD
Idaho MEDICAID 806941900 REGENCE BLUE SHIELD
Idaho Other TA229 REGENCE BLUE SHIELD

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