Provider Demographics
NPI:1427469865
Name:MCDONALD, NICOLE CALKINS (PT, DPT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:CALKINS
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:ANNE
Other - Last Name:CALKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6397 LEE HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2564
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-362-8684
Practice Address - Street 1:60 EXCHANGE ST STE B4
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-7646
Practice Address - Country:US
Practice Address - Phone:912-459-0072
Practice Address - Fax:912-459-0511
Is Sole Proprietor?:No
Enumeration Date:2014-05-19
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014024675225100000X
GAPT011499225100000X
NC14999225100000X
LA08897R225100000X
TN10172225100000X
ALPTH7170225100000X
OHPT.014735225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL102I656584OtherMEDICARE PTAN
LA361704YUZ5OtherMEDICARE PTAN
AL511-51011OtherBCBS-WEST MADISON
MOMA4370087OtherMEDICARE PTAN
AL511-50774OtherBCBS-ATHENS
AL511-51008OtherBCBS-HOOVER
LAUSES NPIOtherBCBS-LA
LA361704YWWBOtherMEDICARE PTAN
AL511-51010OtherBCBS-MOODY
AL511-51009OtherBCBS-CHELSEA