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General NPI Number Information
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NPI Number | 1962046367
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Entity Type | Individual
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Provider Name | NICHOLAS JAMES ANTONIO DPT
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Gender | Male
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Dates
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Enumeration Date | 10/30/2019
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Last Update Date | 12/17/2019
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Provider Practice Location Address
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Address Line | 95 CANAL LANDING BLVD STE 2-3
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City | ROCHESTER
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State | NY
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Zip | 14626-5111
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Country | US
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Telephone | 585-617-0581
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Fax | 585-617-0438
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Provider Business Mailing Address
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Address Line | 427 TRUE HICKORY DR
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City | ROCHESTER
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State | NY
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Zip | 14615-1321
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Country | US
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Telephone | 585-690-7167
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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 | 044497
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License Number State | NY
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