Healthcare Provider Details

I. General information

NPI: 1033416029
Provider Name (Legal Business Name): MICHELLE T NUNNO-EVANS PT,DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2011
Last Update Date: 10/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 SENECA TPKE
CLINTON NY
13323-1027
US

IV. Provider business mailing address

7726 SMITH RD
ROME NY
13440-1522
US

V. Phone/Fax

Practice location:
  • Phone: 315-738-1671
  • Fax:
Mailing address:
  • Phone: 315-337-5389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number007936-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: