Provider Demographics
NPI:1417330986
Name:MISENER, NICHOLAS R (DPT)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:R
Last Name:MISENER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 GEORGETOWN BLVD STE 139
Mailing Address - Street 2:
Mailing Address - City:ELDERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21784-6422
Mailing Address - Country:US
Mailing Address - Phone:410-644-1880
Mailing Address - Fax:443-300-3160
Practice Address - Street 1:6300 GEORGETOWN BLVD STE 139
Practice Address - Street 2:
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-6422
Practice Address - Country:US
Practice Address - Phone:410-644-1880
Practice Address - Fax:443-300-3160
Is Sole Proprietor?:No
Enumeration Date:2015-07-02
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25481225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist