1477807345 NPI number — MR. TERRY EMANUEL NICHOLS P.T.A.

Table of content: MR. TERRY EMANUEL NICHOLS P.T.A. (NPI 1477807345)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477807345 NPI number — MR. TERRY EMANUEL NICHOLS P.T.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NICHOLS
Provider First Name:
TERRY
Provider Middle Name:
EMANUEL
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
P.T.A.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477807345
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/30/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 19155
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUGAR LAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77496-9155
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-969-7137
Provider Business Mailing Address Fax Number:
281-969-8882

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4501 CARTWRIGHT RD
Provider Second Line Business Practice Location Address:
SUITE 606
Provider Business Practice Location Address City Name:
MISSOURI CITY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77459-3541
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-969-7137
Provider Business Practice Location Address Fax Number:
281-969-8882
Provider Enumeration Date:
10/31/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 246ZS0410X , with the licence number:  2087210 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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