Provider Demographics
NPI:1699344549
Name:PIPPERT, NICKOLAS AUSTIN (PT, DPT)
Entity type:Individual
Prefix:
First Name:NICKOLAS
Middle Name:AUSTIN
Last Name:PIPPERT
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 OAK LAWN AVE STE 670
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-4399
Mailing Address - Country:US
Mailing Address - Phone:214-528-3378
Mailing Address - Fax:214-528-3379
Practice Address - Street 1:8070 PARK LN STE 130
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-6439
Practice Address - Country:US
Practice Address - Phone:469-372-0021
Practice Address - Fax:469-372-0029
Is Sole Proprietor?:No
Enumeration Date:2021-06-23
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCP038437T225100000X
TX1347018208100000X
GACP031841T225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation