Basic Information
| Provider Information | |||||||||
| NPI: | 1962973867 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NOVEMBER | ||||||||
| FirstName: | NICHOLAS | ||||||||
| MiddleName: | SCOTT | ||||||||
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| Credential: | PT DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 UNIVERSITY BLVD | ||||||||
| Address2: | |||||||||
| City: | ST AUGUSTINE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320865799 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9048293411 | ||||||||
| FaxNumber: | 9048293412 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 UNIVERSITY BLVD | ||||||||
| Address2: | |||||||||
| City: | ST AUGUSTINE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320865799 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9048293411 | ||||||||
| FaxNumber: | 9048293412 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/17/2018 | ||||||||
| LastUpdateDate: | 12/17/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT33371 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.