Healthcare Provider Details

I. General information

NPI: 1336904911
Provider Name (Legal Business Name): NICOLE ANN PLUMLEY PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2024
Last Update Date: 02/14/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 17TH AVE
VERO BEACH FL
32960-3641
US

IV. Provider business mailing address

545 PITTMAN AVE
VERO BEACH FL
32968-8518
US

V. Phone/Fax

Practice location:
  • Phone: 772-562-6877
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT41343
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: