Individual ProviderSamuel Martin NicholasPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPractice Address1630 Beavercreek Rd, Oregon City, OR 97045-4156(503) 607-0047(503) 489-1174PECOS EnrollmentBased on the most recent information from CMS, provider Samuel Martin Nicholas does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1730785650Provider TypeIndividualFull NameNicholas, Samuel MartinCredentialDPTGenderMaleSole ProprietorNoEnumeration Date12/7/2020Last Updated12/7/2020Contact InformationPractice LocationPractice Address1630 Beavercreek Rd, Oregon City, OR 97045-4156Phone(503) 607-0047Fax(503) 607-0051Mailing LocationMailing AddressPO Box 578, Troutdale, OR 97060-0578Phone(503) 489-1174FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode225100000XPrimaryDescriptionPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicense63810OregonCode225100000XDescriptionPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicenseCP0003840TWashington