Doctor Name: | NICCOLE J MACK |
NPI Number: | 1063401503 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | D.P.T. |
License Number: | 1225 |
Business Practice Address: | 901 4th St Nw Watertown, SD - 572011558 |
Business Phone Number: | 6058868471 |
Business Fax Number: | 6058869317 |
Mailing Address: | Po Box 5074, SIOUX FALLS |
State: | SD |
Postal Code: | 571175074 |
Phone Number: | 6053286585 |
Fax Number: | 6053286512 |
NPI Enumeration Date: | 10/18/2005 |
NPI Last Update Date: | 11/05/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | 1225 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | SD |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |