Provider Demographics
NPI:1992942601
Name:ZOLLER, NICOLE CHRISTINE (MPT)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:CHRISTINE
Last Name:ZOLLER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:CARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6011 N FRESNO ST.
Mailing Address - Street 2:STE 120
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710
Mailing Address - Country:US
Mailing Address - Phone:559-436-8155
Mailing Address - Fax:559-436-8165
Practice Address - Street 1:6011 N FRESNO ST.
Practice Address - Street 2:STE 120
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710
Practice Address - Country:US
Practice Address - Phone:559-436-8155
Practice Address - Fax:559-436-8165
Is Sole Proprietor?:No
Enumeration Date:2009-01-16
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT20417225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ02435ZMedicare PIN