Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 0319291 | NY |
NPI | 1003141110 |
---|---|
Provider Name | Carrie Marie Nicholas |
First Address | Rochester, NY 14623-3057 |
Second Address | Rochester, NY 14623-3057 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2009 |
Last Update Date | 18/02/2014 |