Provider Demographics
NPI:1104893064
Name:PAONESSA, NESTOR HERMINIO (MS, LAT, ATC, CSCS)
Entity type:Individual
Prefix:
First Name:NESTOR
Middle Name:HERMINIO
Last Name:PAONESSA
Suffix:
Gender:M
Credentials:MS, LAT, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 COTSWOLD TER
Mailing Address - Street 2:UNIT 9L
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-8900
Mailing Address - Country:US
Mailing Address - Phone:336-404-0832
Mailing Address - Fax:
Practice Address - Street 1:2402 PINEWAY DR
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-4438
Practice Address - Country:US
Practice Address - Phone:336-584-9848
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC09542255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer