Provider Demographics
NPI:1609209261
Name:DITOMAS, NICOLE C (LMT)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:C
Last Name:DITOMAS
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 1:4630 PERKIOMEN AVE
Mailing Address - Street 2:REAR
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19606-3218
Mailing Address - Country:US
Mailing Address - Phone:610-685-1761
Mailing Address - Fax:
Practice Address - Street 1:4630 PERKIOMEN AVE
Practice Address - Street 2:REAR
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19606-3218
Practice Address - Country:US
Practice Address - Phone:610-685-1761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-18
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA001290225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist