Provider Demographics
NPI:1497220081
Name:FREITAS, NICOLE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:FREITAS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 ROUTE 35, PLAZA 2 SUITE 102
Mailing Address - Street 2:
Mailing Address - City:OCEAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712
Mailing Address - Country:US
Mailing Address - Phone:732-508-9926
Mailing Address - Fax:
Practice Address - Street 1:167 ROUTE 37 W UNIT 2
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-8046
Practice Address - Country:US
Practice Address - Phone:732-508-9926
Practice Address - Fax:732-508-9928
Is Sole Proprietor?:No
Enumeration Date:2018-10-10
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA0180600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist