Provider Demographics
NPI:1659530202
Name:RESNICK, NELL REBECCA (PTA)
Entity Type:Individual
Prefix:MS
First Name:NELL
Middle Name:REBECCA
Last Name:RESNICK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MRS
Other - First Name:NELL
Other - Middle Name:REBECCA
Other - Last Name:NEMETH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:6275 WILD SWAN WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-7418
Mailing Address - Country:US
Mailing Address - Phone:410-916-6281
Mailing Address - Fax:
Practice Address - Street 1:1717 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15227-1744
Practice Address - Country:US
Practice Address - Phone:412-885-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-07
Last Update Date:2008-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE008025225200000X
MDA1992225200000X
CAAT8618225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant