Provider Demographics
NPI:1073234977
Name:FEIST, NICOLE LAURIE
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:LAURIE
Last Name:FEIST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16909 VINTAGE COMMERCE BLVD APT 334
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-5124
Mailing Address - Country:US
Mailing Address - Phone:516-712-7119
Mailing Address - Fax:
Practice Address - Street 1:9918 GULF COAST MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33913-9023
Practice Address - Country:US
Practice Address - Phone:334-934-3258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-08
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049280225100000X
FL140672251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist