Provider Demographics
NPI:1194889451
Name:SCHULKE, NICOLE A (PT, DPT, OCS)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:A
Last Name:SCHULKE
Suffix:
Gender:F
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 CAMLOUGH RD
Mailing Address - Street 2:
Mailing Address - City:WOODBINE
Mailing Address - State:NJ
Mailing Address - Zip Code:08270-3044
Mailing Address - Country:US
Mailing Address - Phone:609-628-1079
Mailing Address - Fax:
Practice Address - Street 1:4 E JIMMIE LEEDS RD
Practice Address - Street 2:SUITE 3
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-4465
Practice Address - Country:US
Practice Address - Phone:609-748-4288
Practice Address - Fax:609-748-4282
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00839600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ090271Medicare ID - Type Unspecified