Provider Demographics
NPI:1215655469
Name:NICHOLSON, THOMAS JOHN (PT, DPT)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:JOHN
Last Name:NICHOLSON
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 HILL COUNTRY DR STE 202
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-6161
Mailing Address - Country:US
Mailing Address - Phone:830-896-4545
Mailing Address - Fax:830-896-4546
Practice Address - Street 1:703 HILL COUNTRY DR STE 202
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-6161
Practice Address - Country:US
Practice Address - Phone:830-896-4545
Practice Address - Fax:830-896-4546
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1366945225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist