Provider Demographics
NPI:1043818867
Name:CLOUDY, NICOLE R (PT, DPT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:R
Last Name:CLOUDY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8627 CINNAMON CREEK DR STE 402
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1482
Mailing Address - Country:US
Mailing Address - Phone:210-888-6042
Mailing Address - Fax:
Practice Address - Street 1:10555 CULEBRA RD STE 103
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-3667
Practice Address - Country:US
Practice Address - Phone:210-888-6042
Practice Address - Fax:210-888-6045
Is Sole Proprietor?:No
Enumeration Date:2020-10-14
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1335341225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist