Provider Demographics
NPI:1124302542
Name:NICHOLS, ERIN ANNE (PT, DPT)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:ANNE
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:ANNE
Other - Last Name:VAN DE VOORT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:
Practice Address - Street 1:225 N MOONLIGHT RD
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:KS
Practice Address - Zip Code:66030-1928
Practice Address - Country:US
Practice Address - Phone:913-856-7927
Practice Address - Fax:913-856-8442
Is Sole Proprietor?:No
Enumeration Date:2011-10-04
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014014158225100000X
KS11-04323225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist