Basic Information
| Provider Information | |||||||||
| NPI: | 1922268796 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NICOLAPT LLC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | CAPE ATLANTIC PHYSICAL THERAPY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 222 NEW RD | ||||||||
| Address2: | BLDG 5 SUITE 503 | ||||||||
| City: | LINWOOD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082211299 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6099261161 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 222 NEW RD BLDG 5 | ||||||||
| Address2: | |||||||||
| City: | LINWOOD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082211299 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6099261161 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2008 | ||||||||
| LastUpdateDate: | 10/18/2012 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| AuthorizedOfficialLastName: | OWEN | ||||||||
| AuthorizedOfficialFirstName: | NICOLA | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6099261161 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
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| AuthorizedOfficialCredential: | P.T. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | 40QA00572700 | NJ | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.