Basic Information
| Provider Information | |||||||||
| NPI: | 1295145936 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TESSIER | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 470 HULON LANE | ||||||||
| Address2: | TTN: VP REVENUE CYCLE | ||||||||
| City: | WEST COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29169 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037912000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 130 FORUM DR STE 113 | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292297943 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8035096880 | ||||||||
| FaxNumber: | 8035096881 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2014 | ||||||||
| LastUpdateDate: | 10/02/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 24243 | FL | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | 225100000X | 9474 | SC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.