Provider Demographics
NPI:1518210491
Name:LANNUTTI, NICOLE CATHERINE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:CATHERINE
Last Name:LANNUTTI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 S OPAL ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19145-4216
Mailing Address - Country:US
Mailing Address - Phone:267-246-3252
Mailing Address - Fax:
Practice Address - Street 1:2420 S OPAL ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145-4216
Practice Address - Country:US
Practice Address - Phone:267-246-3252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-17
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI000378225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant