MEDICARE: NIKOLETTA A BALI-KEYES 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	225100000X	Physical Therapist	028058	NY

General Provider Information

NPI Number	:	1538435458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIKOLETTA A BALI-KEYES PT

Provider Business Mailing Address
First Line	:	1925 SCHIEFFELIN AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10466-5605
Country	:	US
Telephone Number	:	718-654-6377
Fax Number	:

Provider Business Practice Location Address
First Line	:	1925 SCHIEFFELIN AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10466-5605
Country	:	US
Telephone Number	:	718-654-6377
Fax Number	:

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

Provider Enumeration Date	:	03/25/2012
Last Update Date	:	03/25/2012

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