| Deidra Nichols, DPT | |
|
650 N State St, Shelley, ID 83274-4900 | |
| (208) 782-4744 | |
| (208) 906-1554 |
| Full Name | Deidra Nichols |
|---|---|
| Gender | Female |
| Speciality | Physical Therapist |
| Location | 650 N State St, Shelley, Idaho |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225390305 | NPI | - | NPPES |
| 1225390305 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 225100000X | Physical Therapist | PT3043 (Idaho) | Primary |
| Provider Name | Idaho State University |
|---|---|
| Provider Type | Part B Supplier - Clinic/group Practice |
| Provider Identifiers | NPI Number: 1952474777 PECOS PAC ID: 4688683030 Enrollment ID: O20060412000292 |
| Provider Name | Brio Practice Management Idaho Llc |
|---|---|
| Provider Type | Part B Supplier - Clinic/group Practice |
| Provider Identifiers | NPI Number: 1730639642 PECOS PAC ID: 9739462805 Enrollment ID: O20170215002025 |
| Provider Name | Wright Physical Therapy Limited Partnership |
|---|---|
| Provider Type | Part B Supplier - Physical/occupational Therapy Group In Private Practice |
| Provider Identifiers | NPI Number: 1730732025 PECOS PAC ID: 1759612641 Enrollment ID: O20191007003583 |
| Mailing Address | Practice Location Address |
|---|---|
| Deidra Nichols, DPT 650 N State St, Shelley, ID 83274-4900 Ph: (208) 782-4744 | Deidra Nichols, DPT 650 N State St, Shelley, ID 83274-4900 Ph: (208) 782-4744 |
Matthew John Ricci, DPT Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 299 Anderson Rd, Shelley, ID 83274 Phone: 208-782-4744 Fax: 208-906-1554 | |
Joshua Darwin Bischoff, DPT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 299 Anderson Rd, Shelley, ID 83274 Phone: 208-782-4744 Fax: 208-906-1554 | |
Shelley Physical Therapy & Fitness Center Physical Therapist Medicare: Medicare Enrolled Practice Location: 186 W Pine St, Shelley, ID 83274 Phone: 208-680-4787 | |
Chrystal Dawn Browning, PT, DPT, PCS Physical Therapist Medicare: Medicare Enrolled Practice Location: 650 N State St Ste 5, Shelley, ID 83274 Phone: 208-221-4677 Fax: 208-209-6079 | |
William Arnell, DPT Physical Therapist Medicare: Medicare Enrolled Practice Location: 650 N State St Ste 1, Shelley, ID 83274 Phone: 208-782-4744 | |
Kolten D Glider, DPT Physical Therapist Medicare: Medicare Enrolled Practice Location: 299 Anderson Rd, Shelley, ID 83274 Phone: 208-782-4744 Fax: 208-906-1554 |