Provider Demographics
NPI:1316083744
Name:EMMERSON, NICOLE MAGUERITE (PT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:MAGUERITE
Last Name:EMMERSON
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 1:9780 INDEPENDENCE WAY
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80021-4260
Mailing Address - Country:US
Mailing Address - Phone:303-837-2580
Mailing Address - Fax:303-465-5562
Practice Address - Street 1:7577 W 103RD AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80021-5473
Practice Address - Country:US
Practice Address - Phone:303-837-2580
Practice Address - Fax:303-465-5462
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7546225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist