Mack, Niccole J
Mack, Niccole J is an individual health care provider with primary practice located at 901 4Th St Nw , Watertown SD 57201-1558. She recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, which is considered as her primary health care specialty. Mack, Niccole J can be contacted via phone (605) 886-8471.Contact Information
Primary practice address
901 4Th St Nw
Watertown SD 57201-1558
Phone: (605) 886-8471
Fax: (605) 886-9317
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist | 225100000X | 1225 | South Dakota |
Profile Details
| NPI number | 1063401503 |
|---|---|
| LBN Legal business name | Mack, Niccole J |
| Credentials | D.P.T. |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 18th, 2005 |
| Last updated | Nov 5th, 2013 - about 11 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1063401503 | NPPES |
| South Dakota | MEDICAID | 5834040 |
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