Provider Demographics
NPI:1962931022
Name:PIEPER, NICHOLAS FRANCIS (PTA/ L)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:FRANCIS
Last Name:PIEPER
Suffix:
Gender:M
Credentials:PTA/ L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2806 EGRETS LANDING DR
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-7412
Mailing Address - Country:US
Mailing Address - Phone:407-592-7000
Mailing Address - Fax:
Practice Address - Street 1:2806 EGRETS LANDING DR
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-7412
Practice Address - Country:US
Practice Address - Phone:407-592-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA24025225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant