MEDICARE: MRS. NICOLE P DEMETRESCU PT

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	174400000X	Specialist	PT60283444	WA

General Provider Information

NPI Number	:	1255687083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NICOLE P DEMETRESCU PT

Provider Business Mailing Address
First Line	:	209 MAIN AVE S
Second Line	:	SUITE 111
City	:	NORTH BEND
State	:	WA
Zip	:	98045-8139
Country	:	US
Telephone Number	:	425-888-3347
Fax Number	:	425-888-3348

Provider Business Practice Location Address
First Line	:	209 MAIN AVE S
Second Line	:	SUITE 111
City	:	NORTH BEND
State	:	WA
Zip	:	98045-8139
Country	:	US
Telephone Number	:	425-888-3347
Fax Number	:	425-888-3348

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

Provider Enumeration Date	:	07/30/2012
Last Update Date	:	07/30/2012

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