Provider Demographics
NPI:1003217324
Name:MIANO, NICHOLAS (PTA)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:MIANO
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 WINTERBERRY RD
Mailing Address - Street 2:
Mailing Address - City:SAUNDERSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02874-2438
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:129 WINTERBERRY RD
Practice Address - Street 2:
Practice Address - City:SAUNDERSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02874-2438
Practice Address - Country:US
Practice Address - Phone:401-932-1603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-05
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPTA00993225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant