Provider Demographics
NPI:1982688974
Name:MACALUSO, NICOLE SMYTH (PT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:SMYTH
Last Name:MACALUSO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:SMYTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:214 2ND ST E
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-2436
Mailing Address - Country:US
Mailing Address - Phone:406-730-2224
Mailing Address - Fax:406-730-2228
Practice Address - Street 1:214 2ND ST E
Practice Address - Street 2:
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937-2436
Practice Address - Country:US
Practice Address - Phone:406-730-2224
Practice Address - Fax:406-730-2228
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPTP-PT-LIC-19225225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP01683737OtherRR MEDICARE
WA8432437Medicaid
WA1982688974Medicaid
WA8855015Medicare PIN