Provider Demographics
NPI:1508110750
Name:MCNAMARA, NICHOLE SIERRA (PT)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:SIERRA
Last Name:MCNAMARA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:NICHOLE
Other - Middle Name:SIERRA
Other - Last Name:VELTRI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:501 OGDEN ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-4325
Mailing Address - Country:US
Mailing Address - Phone:210-225-4588
Mailing Address - Fax:
Practice Address - Street 1:501 OGDEN ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212
Practice Address - Country:US
Practice Address - Phone:210-225-4588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-08
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035819225100000X
TX1235340225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP01355979OtherRR MEDICARE
NYP01355979OtherRR MEDICARE