MEDICARE: NICHOLE IRWIN PT

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	225100000X	Physical Therapist	PT015853	PA

General Provider Information

NPI Number	:	1205890266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLE IRWIN PT

Provider Business Mailing Address
First Line	:	4343 BRISTOL ST
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15207-1421
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3459 5TH AVE
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15213-3236
Country	:	US
Telephone Number	:	412-647-6017
Fax Number	:

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

Provider Enumeration Date	:	04/14/2006
Last Update Date	:	07/08/2007

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