Provider Demographics
NPI:1194083816
Name:HUFFMAN, NIKKI SHEA (PT)
Entity type:Individual
Prefix:
First Name:NIKKI
Middle Name:SHEA
Last Name:HUFFMAN
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 1:4000 AVONLEA PL
Mailing Address - Street 2:APT 308
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-4899
Mailing Address - Country:US
Mailing Address - Phone:828-455-6041
Mailing Address - Fax:
Practice Address - Street 1:620 J L WHITE DR STE 110
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-4897
Practice Address - Country:US
Practice Address - Phone:706-692-9080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-01
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT27297225100000X
GAPT010629225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist