Nicol Ruth Himelick, PTA
Individual provider Active NPI Physical Therapy Assistant · Marrion, IL
NPI 1487716874 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1487716874
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapy Assistant 225200000X
- Practice address
- 2907 Williamson County Pkwy
Marrion, IL 62959 - Phone
- (618) 998-9894
- NPI assigned
- Dec 14, 2006
- 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 |
|---|---|---|---|
| 160003418 | IL | MD | Physical Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | IL | Yes |
Addresses
Primary practice location
2907 Williamson County Pkwy
Marrion, IL 62959
Mailing address
1520 W Stotlar
Herrin, IL 62948
Phone (618) 942-8768
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. 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.