MEDICARE: NICOLE VENEZIANO PT, DPT, OCS

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	035105	NY

General Provider Information

NPI Number	:	1922401017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE VENEZIANO PT, DPT, OCS

Provider Business Mailing Address
First Line	:	576 BROADHOLLOW RD
Second Line	:
City	:	MELVILLE
State	:	NY
Zip	:	11747-5002
Country	:	US
Telephone Number	:	631-359-5859
Fax Number	:

Provider Business Practice Location Address
First Line	:	94 W MAIN ST
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-8365
Country	:	US
Telephone Number	:	631-983-3724
Fax Number	:	631-223-4765

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

Provider Enumeration Date	:	10/02/2014
Last Update Date	:	02/07/2022

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