Provider Demographics
NPI:1225582539
Name:SILLS, NICOLE (PT, DPT, OCS)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:SILLS
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 1:2373 HIGHWAY 36
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC HIGHLANDS
Mailing Address - State:NJ
Mailing Address - Zip Code:07716-2560
Mailing Address - Country:US
Mailing Address - Phone:732-872-6595
Mailing Address - Fax:
Practice Address - Street 1:2373 HIGHWAY 36
Practice Address - Street 2:
Practice Address - City:ATLANTIC HIGHLANDS
Practice Address - State:NJ
Practice Address - Zip Code:07716-2560
Practice Address - Country:US
Practice Address - Phone:732-872-6595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT11107225100000X
NJ40QA02203400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist