Provider Demographics
NPI:1275148496
Name:MAESTRI, NICOLE S
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:S
Last Name:MAESTRI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:SADOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13950 MONTICELLO ST
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33325-1262
Mailing Address - Country:US
Mailing Address - Phone:305-439-0535
Mailing Address - Fax:
Practice Address - Street 1:15291 NW 60TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2459
Practice Address - Country:US
Practice Address - Phone:305-705-7702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-14
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT36015225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist