MEDICARE: MS. NICOLE ANN NEWHART 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
1	2081P0010X	Pediatric Rehabilitation Medicine Physician	025345	NY
2	225100000X	Physical Therapist	025345	NY

General Provider Information

NPI Number	:	1245289982
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NICOLE ANN NEWHART DPT

Provider Business Mailing Address
First Line	:	4 LEA AVE
Second Line	:
City	:	MANORVILLE
State	:	NY
Zip	:	11949-2920
Country	:	US
Telephone Number	:	631-655-5553
Fax Number	:

Provider Business Practice Location Address
First Line	:	4 LEA AVE
Second Line	:
City	:	MANORVILLE
State	:	NY
Zip	:	11949-2920
Country	:	US
Telephone Number	:	631-655-5553
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	04/25/2024

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