Provider Demographics
NPI:1427648880
Name:TALSMA, NIKALAS (PTA)
Entity type:Individual
Prefix:
First Name:NIKALAS
Middle Name:
Last Name:TALSMA
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 BONANZA DR
Mailing Address - Street 2:
Mailing Address - City:RICHLANDS
Mailing Address - State:NC
Mailing Address - Zip Code:28574-8399
Mailing Address - Country:US
Mailing Address - Phone:910-375-2216
Mailing Address - Fax:
Practice Address - Street 1:1304 SE SECOND ST
Practice Address - Street 2:
Practice Address - City:SNOW HILL
Practice Address - State:NC
Practice Address - Zip Code:28580-2014
Practice Address - Country:US
Practice Address - Phone:252-747-8126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-20
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA7403208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation