Provider Demographics
NPI:1710183876
Name:TIROL-CABITAC, NICOLE (PT)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:
Last Name:TIROL-CABITAC
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 1:13 PUTNAM AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-3215
Mailing Address - Country:US
Mailing Address - Phone:516-837-0882
Mailing Address - Fax:
Practice Address - Street 1:13 PUTNAM AVE
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-3215
Practice Address - Country:US
Practice Address - Phone:516-837-0882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022799225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist