Provider Demographics
NPI:1306572847
Name:NOLAN, IAN CHRISTOPHER (PTA)
Entity type:Individual
Prefix:
First Name:IAN
Middle Name:CHRISTOPHER
Last Name:NOLAN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9398 VERCELLI ST
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-5212
Mailing Address - Country:US
Mailing Address - Phone:609-310-8311
Mailing Address - Fax:
Practice Address - Street 1:9398 VERCELLI ST
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-5212
Practice Address - Country:US
Practice Address - Phone:609-310-8311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL32182225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant