Provider Demographics
NPI:1871265991
Name:CAMPORESE, NICOLE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:CAMPORESE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 ALPINE LN
Mailing Address - Street 2:
Mailing Address - City:SCHOHARIE
Mailing Address - State:NY
Mailing Address - Zip Code:12157-2706
Mailing Address - Country:US
Mailing Address - Phone:646-772-1915
Mailing Address - Fax:
Practice Address - Street 1:112 ALPINE LN
Practice Address - Street 2:
Practice Address - City:SCHOHARIE
Practice Address - State:NY
Practice Address - Zip Code:12157-2706
Practice Address - Country:US
Practice Address - Phone:646-772-1915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-28
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046404208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation