Basic Information
| Provider Information | |||||||||
| NPI: | 1033416029 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NUNNO-EVANS | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | T | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | PT,DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7726 SMITH RD | ||||||||
| Address2: | |||||||||
| City: | ROME | ||||||||
| State: | NY | ||||||||
| PostalCode: | 134401522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3153375389 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8200 SENECA TPKE | ||||||||
| Address2: | |||||||||
| City: | CLINTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 133231027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3157381671 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2011 | ||||||||
| LastUpdateDate: | 10/13/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 007936-1 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.