Nichole Cruzan, DPT
Individual provider Active NPI Physical Therapist · Fremont, MI
NPI 1083117196 · NPPES record last updated Mar 15, 2018
Key facts
- NPI
- 1083117196
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 5501017803 (MI)
- Practice address
- 1401 W Main St
Fremont, MI 49412-1486 - Phone
- (231) 924-3998
- NPI assigned
- Mar 15, 2018
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5501017803 | MI | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 5501017803 | MI | Yes |
Addresses
Primary practice location
1401 W Main St
Fremont, MI 49412-1486
Mailing address
4919 S Green Ave
Fremont, MI 49412-8508
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All providers in Fremont, MI · Physical Therapist in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 15, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.