Provider Demographics
NPI:1225303753
Name:BAILEY, NICOLE LYNN
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:LYNN
Last Name:BAILEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:LYNN
Other - Last Name:ZEHNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:3430 SUMMER VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:NEW RINGGOLD
Mailing Address - State:PA
Mailing Address - Zip Code:17960-9376
Mailing Address - Country:US
Mailing Address - Phone:570-778-3311
Mailing Address - Fax:
Practice Address - Street 1:125 HOLLY RD
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:PA
Practice Address - Zip Code:19526-8729
Practice Address - Country:US
Practice Address - Phone:610-562-2284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-16
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI001757225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant