Provider Demographics
NPI:1891530234
Name:NICK, SEAN J (PT, DPT)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:J
Last Name:NICK
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 W 27TH ST
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-4975
Mailing Address - Country:US
Mailing Address - Phone:440-650-1884
Mailing Address - Fax:440-997-5486
Practice Address - Street 1:2579 WALTER GREEN CMNS
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:OH
Practice Address - Zip Code:44057-2449
Practice Address - Country:US
Practice Address - Phone:440-466-5447
Practice Address - Fax:440-466-5455
Is Sole Proprietor?:No
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT021068225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist