Provider Demographics
NPI:1992267876
Name:NICHOLSON, KATLIN MICHELE
Entity type:Individual
Prefix:
First Name:KATLIN
Middle Name:MICHELE
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 NE RAVENNA BLVD
Mailing Address - Street 2:UNIT 101
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-8448
Mailing Address - Country:US
Mailing Address - Phone:206-524-4977
Mailing Address - Fax:206-524-4340
Practice Address - Street 1:432 NE RAVENNA BLVD
Practice Address - Street 2:UNIT 101
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-8448
Practice Address - Country:US
Practice Address - Phone:206-524-4977
Practice Address - Fax:206-524-4340
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-01
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT34419225100000X
WAPT60941291225100000X
NMPT5468225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist