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General NPI Number Information
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NPI Number | 1023667227
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Entity Type | Individual
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Provider Name | NICHOLAS JOSEPH MUNRO DPT
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Gender | Male
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Dates
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Enumeration Date | 09/10/2019
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Last Update Date | 09/10/2019
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Provider Practice Location Address
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Address Line | 6620 FLY RD STE 102
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City | EAST SYRACUSE
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State | NY
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Zip | 13057-4281
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Country | US
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Telephone | 315-399-4770
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Fax | 315-399-4771
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Provider Business Mailing Address
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Address Line | 110 POLK ST APT 13
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City | SYRACUSE
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State | NY
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Zip | 13224-1357
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Country | US
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Telephone | 862-268-4184
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 044617-01
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License Number State | NY
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