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NPI Code Detail

MEDICARE: MRS. LAUREN TERESA NICHOLSON P.T.

MEDICARE: MRS. LAUREN TERESA NICHOLSON P.T.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist023892NY

General Provider Information

NPI Number : 1104971324
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LAUREN TERESA NICHOLSON P.T.
Provider Business Mailing Address
First Line : 20 WALNUT STREET
Second Line : SUITE B
City : MONTGOMERY
State : NY
Zip : 12549
Country : US
Telephone Number : 845-457-5555
Fax Number :
Provider Business Practice Location Address
First Line : 20 WALNUT ST
Second Line : SUITE B
City : MONTGOMERY
State : NY
Zip : 12549-2230
Country : US
Telephone Number : 845-457-5555
Fax Number : 845-457-5556
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/25/2007
Last Update Date : 04/16/2008

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