Provider Demographics
NPI:1396145348
Name:MIKKELSEN, NICHOLAS (PT)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:MIKKELSEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 BROOK HL
Mailing Address - Street 2:
Mailing Address - City:MEREDITH
Mailing Address - State:NH
Mailing Address - Zip Code:03253-7129
Mailing Address - Country:US
Mailing Address - Phone:401-447-2168
Mailing Address - Fax:
Practice Address - Street 1:780 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246-2756
Practice Address - Country:US
Practice Address - Phone:603-224-4093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-27
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH4203225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist