Provider Demographics
NPI:1477192417
Name:NICOSIA, SALVATORE LOUIS JR
Entity Type:Individual
Prefix:
First Name:SALVATORE
Middle Name:LOUIS
Last Name:NICOSIA
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 PEPPER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SPRING MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:16875-9339
Mailing Address - Country:US
Mailing Address - Phone:814-876-0390
Mailing Address - Fax:
Practice Address - Street 1:202 PEPPER RIDGE DR
Practice Address - Street 2:
Practice Address - City:SPRING MILLS
Practice Address - State:PA
Practice Address - Zip Code:16875-9339
Practice Address - Country:US
Practice Address - Phone:814-876-0390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-21
Last Update Date:2019-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer