Provider Demographics
NPI:1316350424
Name:HARSHBARGER, NICOLE (ATC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:HARSHBARGER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 E BROADWAY RD
Mailing Address - Street 2:2025
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-1639
Mailing Address - Country:US
Mailing Address - Phone:505-699-0868
Mailing Address - Fax:
Practice Address - Street 1:1440 E BROADWAY RD
Practice Address - Street 2:2025
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-1639
Practice Address - Country:US
Practice Address - Phone:505-699-0868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-05
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10482255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer