Provider Demographics
NPI:1528036530
Name:NEVOLA, NANDA J (PT, PC)
Entity Type:Individual
Prefix:
First Name:NANDA
Middle Name:J
Last Name:NEVOLA
Suffix:
Gender:F
Credentials:PT, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:UPPER NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-1320
Mailing Address - Country:US
Mailing Address - Phone:845-348-8700
Mailing Address - Fax:845-348-8701
Practice Address - Street 1:TA RA INSTITUTE
Practice Address - Street 2:104 LAKE RD
Practice Address - City:VALLEY COTTAGE
Practice Address - State:NY
Practice Address - Zip Code:10989-2339
Practice Address - Country:US
Practice Address - Phone:845-300-2847
Practice Address - Fax:668-412-4528
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY015158225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist