Provider Demographics
NPI:1316988777
Name:CULLENS, NICOLE LEIGH (PT)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:LEIGH
Last Name:CULLENS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:LEIGH
Other - Last Name:SUTHERLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:4118 CONSTITUTION DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-6317
Mailing Address - Country:US
Mailing Address - Phone:214-763-1850
Mailing Address - Fax:
Practice Address - Street 1:4118 CONSTITUTION DR
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-6317
Practice Address - Country:US
Practice Address - Phone:214-763-1850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1127223225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8E0082Medicare ID - Type UnspecifiedPROVIDER ID NUMBER
TX00626YMedicare ID - Type UnspecifiedGROUP ID NUMBER