Provider Demographics
NPI:1699711788
Name:NICHOLS, ALLAN ROMINE (PT)
Entity type:Individual
Prefix:
First Name:ALLAN
Middle Name:ROMINE
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10452 SILVERDALE WAY NW
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-9411
Mailing Address - Country:US
Mailing Address - Phone:360-307-7500
Mailing Address - Fax:360-307-7530
Practice Address - Street 1:9621 RIDGETOP BLVD NW
Practice Address - Street 2:SUITE 100
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8502
Practice Address - Country:US
Practice Address - Phone:360-782-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008362225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8424244Medicaid
WA195813OtherLABOR & INDUSTRIES
7166701OtherAETNA
8918NIOtherREGENCE BLUESHIELD
WAG8852967Medicare PIN
WA195813OtherLABOR & INDUSTRIES