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General NPI Number Information
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NPI Number | 1932930757
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Entity Type | Individual
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Provider Name | NICHOLAS QUEIROZ PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 08/13/2024
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Last Update Date | 10/07/2025
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Provider Practice Location Address
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Address Line | 520 HARTFORD TPKE
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City | VERNON
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State | CT
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Zip | 06066-5037
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Country | US
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Telephone | 860-870-0760
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Fax |
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Provider Business Mailing Address
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Address Line | 2 TRAIL RUN APT 8311
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City | VERNON
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State | CT
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Zip | 06066-3992
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Country | US
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Telephone | 860-816-5827
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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 | 15139
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 27792
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License Number State | MA
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