Provider Demographics
NPI:1194015081
Name:FUZIE, NICOLE BETH (LMT)
Entity Type:Individual
Prefix:MISS
First Name:NICOLE
Middle Name:BETH
Last Name:FUZIE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 GARDINER DR
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-6313
Mailing Address - Country:US
Mailing Address - Phone:631-365-0079
Mailing Address - Fax:
Practice Address - Street 1:1075 GARDINER DR
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-6313
Practice Address - Country:US
Practice Address - Phone:631-365-0079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-12
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024023225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist