Provider Demographics
NPI:1568646719
Name:VIENI, NICOLE CARLA (PT CSCS)
Entity Type:Individual
Prefix:MISS
First Name:NICOLE
Middle Name:CARLA
Last Name:VIENI
Suffix:
Gender:F
Credentials:PT CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4901 LAC DEVILLE BOULEVARD
Mailing Address - Street 2:SUITE 110 BUILDING D
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618
Mailing Address - Country:US
Mailing Address - Phone:585-341-9150
Mailing Address - Fax:
Practice Address - Street 1:4901 LAC DEVILLE BLVD
Practice Address - Street 2:SUITE 110 BUILDING D
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618
Practice Address - Country:US
Practice Address - Phone:585-341-9150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0243942251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic