MEDICARE: NICHOLAS GENTILEZZA

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
1	225200000X	Physical Therapy Assistant	TEI003421	PA

General Provider Information

NPI Number	:	1114552064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS GENTILEZZA

Provider Business Mailing Address
First Line	:	185 GREENFIELD RD
Second Line	:
City	:	SCOTT TWP
State	:	PA
Zip	:	18433-7761
Country	:	US
Telephone Number	:	570-479-0982
Fax Number	:

Provider Business Practice Location Address
First Line	:	185 GREENFIELD RD
Second Line	:
City	:	SCOTT TWP
State	:	PA
Zip	:	18433-7761
Country	:	US
Telephone Number	:	570-479-0982
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2020
Last Update Date	:	03/10/2020

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Directions to “ NICHOLAS GENTILEZZA ” Practice Location

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