MEDICARE: NICOLE MARIE PICCININNI PT, DPT

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

General Provider Information

NPI Number	:	1427561646
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE MARIE PICCININNI PT, DPT

Provider Business Mailing Address
First Line	:	7 CARNEGIE PLZ
Second Line	:
City	:	CHERRY HILL
State	:	NJ
Zip	:	08003-1000
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1415 RICHMOND AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-1553
Country	:	US
Telephone Number	:	877-407-3422
Fax Number	:

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

Provider Enumeration Date	:	11/09/2017
Last Update Date	:	11/09/2017

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