Provider Demographics
NPI:1063107118
Name:NIKAO PHYSICAL THERAPY, PLLC
Entity type:Organization
Organization Name:NIKAO PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:GULLEDGE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:480-524-0321
Mailing Address - Street 1:2121 S MILL AVE STE 209
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-2136
Mailing Address - Country:US
Mailing Address - Phone:480-524-0321
Mailing Address - Fax:480-420-4139
Practice Address - Street 1:2121 S MILL AVE STE 209
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-2136
Practice Address - Country:US
Practice Address - Phone:480-524-0321
Practice Address - Fax:480-420-4139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-05
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty