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NPI Code Detail

MEDICARE: MS. NICOLE KRISTEN DANELUTTI MSPT

MEDICARE: MS. NICOLE KRISTEN DANELUTTI MSPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistPA017240PA

General Provider Information

NPI Number : 1114975240
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. NICOLE KRISTEN DANELUTTI MSPT
Provider Business Mailing Address
First Line : 827 NORTH ST
Second Line :
City : COLLINGDALE
State : PA
Zip : 19023-3528
Country : US
Telephone Number : 610-306-4391
Fax Number :
Provider Business Practice Location Address
First Line : 2906 ISLAND AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19153-2026
Country : US
Telephone Number : 215-365-2113
Fax Number : 215-365-5516
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2006
Last Update Date : 07/08/2007

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