Provider Demographics
NPI:1396173068
Name:NORTH, NICHOLAS L (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:L
Last Name:NORTH
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:DR
Other - First Name:NICHOLAS
Other - Middle Name:L
Other - Last Name:KULESA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:225 NE LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4553
Mailing Address - Country:US
Mailing Address - Phone:303-710-1238
Mailing Address - Fax:
Practice Address - Street 1:225 NE LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4553
Practice Address - Country:US
Practice Address - Phone:303-710-1238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-16
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR647892251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic