Provider Demographics
NPI:1790804771
Name:NICI, LINDA JILL (PT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:JILL
Last Name:NICI
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 1:570 KNOLL CT
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11783-1119
Mailing Address - Country:US
Mailing Address - Phone:516-796-0783
Mailing Address - Fax:516-745-1177
Practice Address - Street 1:570 KNOLL CT
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:NY
Practice Address - Zip Code:11783-1119
Practice Address - Country:US
Practice Address - Phone:516-796-0783
Practice Address - Fax:516-745-1177
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009963-12251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics