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NPI Code Detail

MEDICARE: NICOLE JUNE BRISSETTE DPT

MEDICARE: NICOLE JUNE BRISSETTE DPT
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 Therapist053649NY

General Provider Information

NPI Number : 1134944317
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE JUNE BRISSETTE DPT
Provider Business Mailing Address
First Line : 16 MAYBROOK RD STE L
Second Line :
City : CAMPBELL HALL
State : NY
Zip : 10916-2741
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1450 ROUTE 208
Second Line :
City : WALLKILL
State : NY
Zip : 12589-3799
Country : US
Telephone Number : 845-895-1115
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/21/2024
Last Update Date : 11/21/2024

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Directions to “ NICOLE JUNE BRISSETTE DPT” Practice Location

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