Provider Demographics
NPI:1083047039
Name:SCHRECENGOST, NICOLE MARIE (PT, DPT)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:MARIE
Last Name:SCHRECENGOST
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 STANBRIDGE ST
Mailing Address - Street 2:APT A519
Mailing Address - City:EAST NORRITON
Mailing Address - State:PA
Mailing Address - Zip Code:19401-1608
Mailing Address - Country:US
Mailing Address - Phone:814-316-1438
Mailing Address - Fax:
Practice Address - Street 1:2400 WILDWOOD RD
Practice Address - Street 2:
Practice Address - City:GIBSONIA
Practice Address - State:PA
Practice Address - Zip Code:15044-6404
Practice Address - Country:US
Practice Address - Phone:412-487-7771
Practice Address - Fax:412-487-7772
Is Sole Proprietor?:No
Enumeration Date:2013-08-14
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT023080225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103425812-0001Medicaid
PA103425812-0002Medicaid
PAPT023080OtherSTATE LICENSE