Provider Demographics
NPI:1558305904
Name:SCHLOSSER, NICOLE (PT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:SCHLOSSER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 S MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE PLACID
Mailing Address - State:FL
Mailing Address - Zip Code:33852-1808
Mailing Address - Country:US
Mailing Address - Phone:863-699-6929
Mailing Address - Fax:863-699-6926
Practice Address - Street 1:104 S MAIN AVE
Practice Address - Street 2:
Practice Address - City:LAKE PLACID
Practice Address - State:FL
Practice Address - Zip Code:33852-1808
Practice Address - Country:US
Practice Address - Phone:863-699-6929
Practice Address - Fax:863-699-6926
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT14140225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00406934OtherRAILROAD MEDICARE
FLU0400ZMedicare PIN