Healthcare Provider Details

I. General information

NPI: 1184221558
Provider Name (Legal Business Name): NISHANI CICILSON PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2020
Last Update Date: 10/07/2020
Certification Date: 10/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3349 WILMINGTON RD
NEW CASTLE PA
16105-1038
US

IV. Provider business mailing address

7492 OREGON TRL
YOUNGSTOWN OH
44512-5537
US

V. Phone/Fax

Practice location:
  • Phone: 724-598-3432
  • Fax:
Mailing address:
  • Phone: 330-942-6369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT025266
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: