Provider Demographics
NPI:1609157627
Name:APPLE, NEDRA MAE (LMT)
Entity Type:Individual
Prefix:
First Name:NEDRA
Middle Name:MAE
Last Name:APPLE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 PINE AVE
Mailing Address - Street 2:
Mailing Address - City:WYNANTSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12198-7555
Mailing Address - Country:US
Mailing Address - Phone:518-925-9611
Mailing Address - Fax:
Practice Address - Street 1:830 HOOSICK RD
Practice Address - Street 2:SUITE 1
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-6665
Practice Address - Country:US
Practice Address - Phone:518-925-9611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-03
Last Update Date:2011-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022945225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist