Provider Demographics
NPI:1073737862
Name:PESCE, NICK B JR (PT)
Entity Type:Individual
Prefix:
First Name:NICK
Middle Name:B
Last Name:PESCE
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 S PRESCOTT ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111-4635
Mailing Address - Country:US
Mailing Address - Phone:901-257-3422
Mailing Address - Fax:901-257-3423
Practice Address - Street 1:80 S PRESCOTT ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38111
Practice Address - Country:US
Practice Address - Phone:901-257-3422
Practice Address - Fax:901-257-3423
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT0000001467225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist