Provider Demographics
NPI:1306192067
Name:DREW, NICOLE D (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:D
Last Name:DREW
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:D
Other - Last Name:DEVITO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:9 HEDGES RD
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07930-2103
Mailing Address - Country:US
Mailing Address - Phone:908-887-9911
Mailing Address - Fax:201-795-0007
Practice Address - Street 1:9 HEDGES RD
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:NJ
Practice Address - Zip Code:07930-2103
Practice Address - Country:US
Practice Address - Phone:908-887-9911
Practice Address - Fax:201-795-0007
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-31
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA008483002251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics