Basic Information
| Provider Information | |||||||||
| NPI: | 1407040124 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NICHOLAS-KARL | ||||||||
| FirstName: | MORRETTE | ||||||||
| MiddleName: | SOPHIA | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PHYSICAL THERAPIST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2252 WAYCROSS RD | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452402743 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137422333 | ||||||||
| FaxNumber: | 5137420943 | ||||||||
| Practice Location | |||||||||
| Address1: | 6432 LAKE WORTH RD | ||||||||
| Address2: | |||||||||
| City: | GREENACRES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334633008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5614331884 | ||||||||
| FaxNumber: | 5614331885 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2007 | ||||||||
| LastUpdateDate: | 09/06/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT23434 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.