Provider Demographics
NPI:1730643164
Name:RAPPORT, NICHOLAS GEOFFREY
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:GEOFFREY
Last Name:RAPPORT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 E WHARF RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-3115
Mailing Address - Country:US
Mailing Address - Phone:203-640-1065
Mailing Address - Fax:
Practice Address - Street 1:63 E WHARF RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-3115
Practice Address - Country:US
Practice Address - Phone:203-640-1065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-30
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer