Provider Demographics
NPI:1962050229
Name:KOELLNER, NIKOLE ASHTON (PT, DPT)
Entity type:Individual
Prefix:
First Name:NIKOLE
Middle Name:ASHTON
Last Name:KOELLNER
Suffix:
Gender:F
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 1:6397 LEE HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-4915
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:2850 HOLCOMB BRIDGE RD STE 140A
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-1658
Practice Address - Country:US
Practice Address - Phone:678-585-7921
Practice Address - Fax:678-585-7923
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-29
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT014304225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist