Basic Information
| Provider Information | |||||||||
| NPI: | 1336532027 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NICOSIA | ||||||||
| FirstName: | ANDREA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24 BROOK HILL LN APT F | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146252243 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5187740044 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2111 HUDSON AVE | ||||||||
| Address2: | |||||||||
| City: | IRONDEQUOIT | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146174346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5854674567 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2015 | ||||||||
| LastUpdateDate: | 03/05/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 036494-1 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.