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General NPI Number Information
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NPI Number | 1073665543
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Entity Type | Individual
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Provider Name | NICOLE DONNELLY MPT
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Gender | Female
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1111 STREET RD
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City | SOUTHAMPTON
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State | PA
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Zip | 18966-4250
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Country | US
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Telephone | 215-675-4466
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Fax | 215-675-3711
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Provider Business Mailing Address
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Address Line | 2539 FERNWOOD AVE
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City | ROSLYN
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State | PA
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Zip | 19001-3002
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Country | US
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Telephone | 215-887-5859
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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 | PT017008
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License Number State | PA
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