Provider Demographics
NPI:1124146584
Name:NICKEL, JOYCE ANNETTE (PT)
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:ANNETTE
Last Name:NICKEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5265 N MCKINLEY RD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:MI
Mailing Address - Zip Code:48433-1115
Mailing Address - Country:US
Mailing Address - Phone:810-659-2747
Mailing Address - Fax:810-342-5589
Practice Address - Street 1:2500 N ELMS RD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:MI
Practice Address - Zip Code:48433-9426
Practice Address - Country:US
Practice Address - Phone:810-342-5556
Practice Address - Fax:810-342-5589
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010320225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist