Healthcare Provider Details

I. General information

NPI: 1508010786
Provider Name (Legal Business Name): NICOLE JANINE WOJNO PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2008
Last Update Date: 10/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 ROBIN LN 11U
BAYSIDE NY
11360-1136
US

IV. Provider business mailing address

2568 SW GREENWICH WAY
PALM CITY FL
34990-7507
US

V. Phone/Fax

Practice location:
  • Phone: 786-258-3763
  • Fax:
Mailing address:
  • Phone: 786-258-3763
  • Fax: 772-212-7482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number028736
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number22612
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: