Provider Demographics
NPI:1871005421
Name:MAGGIO, NICHOLAS MATTHEW (DPT)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:MATTHEW
Last Name:MAGGIO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2125 NOLL DR STE 100
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-7607
Mailing Address - Country:US
Mailing Address - Phone:717-391-9920
Mailing Address - Fax:717-391-9925
Practice Address - Street 1:2125 NOLL DR STE 100
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-7607
Practice Address - Country:US
Practice Address - Phone:717-391-9920
Practice Address - Fax:717-391-9925
Is Sole Proprietor?:No
Enumeration Date:2017-11-03
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT026583225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist