Basic Information
| Provider Information | |||||||||
| NPI: | 1013242130 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NICHOLAS | ||||||||
| FirstName: | JUNE | ||||||||
| MiddleName: | CAROL | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | P.T. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | PROTZKO | ||||||||
| OtherFirstName: | JUNE | ||||||||
| OtherMiddleName: | CAROL | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 10 WARREN RD | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | COCKEYSVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210302506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106839900 | ||||||||
| FaxNumber: | 4106833355 | ||||||||
| Practice Location | |||||||||
| Address1: | 10 WARREN RD | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | COCKEYSVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210302506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106839900 | ||||||||
| FaxNumber: | 4106833355 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2009 | ||||||||
| LastUpdateDate: | 10/07/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 15843 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.