Provider Demographics
NPI:1427740976
Name:NICOLAS, ROBERT A (DPT)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:NICOLAS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 S D ST
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1854
Mailing Address - Country:US
Mailing Address - Phone:956-375-2216
Mailing Address - Fax:
Practice Address - Street 1:1512 E GRIFFIN PKWY STE 10
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-2416
Practice Address - Country:US
Practice Address - Phone:956-997-0201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-23
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1376099225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist