Provider Demographics
NPI:1770817843
Name:NESDILL, JIM A (PT)
Entity Type:Individual
Prefix:MR
First Name:JIM
Middle Name:A
Last Name:NESDILL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CARMANS RD
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA PK
Mailing Address - State:NY
Mailing Address - Zip Code:11762-1438
Mailing Address - Country:US
Mailing Address - Phone:516-608-6200
Mailing Address - Fax:
Practice Address - Street 1:1 CARMANS RD
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA PK
Practice Address - State:NY
Practice Address - Zip Code:11762-1438
Practice Address - Country:US
Practice Address - Phone:516-608-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-23
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014385-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist