Provider Demographics
NPI:1164701439
Name:NOLAN, NICOLE L (DPT)
Entity Type:Individual
Prefix:MISS
First Name:NICOLE
Middle Name:L
Last Name:NOLAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVE BOX 665
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-341-9200
Mailing Address - Fax:
Practice Address - Street 1:1835 FAIRPORT NINE MILE POINT RD
Practice Address - Street 2:
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526-1903
Practice Address - Country:US
Practice Address - Phone:585-341-9200
Practice Address - Fax:585-697-0209
Is Sole Proprietor?:No
Enumeration Date:2011-08-04
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY340362084P0804X
NY034036-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry