MEDICARE: MARISA NICOLETTI

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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1396238028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISA NICOLETTI

Provider Business Mailing Address
First Line	:	1435 ESTRELLA DR
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93110-2419
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1435 ESTRELLA DR
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93110-2419
Country	:	US
Telephone Number	:	805-708-1657
Fax Number	:

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

Provider Enumeration Date	:	06/07/2018
Last Update Date	:	06/07/2018

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