Provider Demographics
NPI:1184213738
Name:DAILEY, NICOLE MELANIE-BERMAN (PT, DPT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:MELANIE-BERMAN
Last Name:DAILEY
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 1:3236 TYLER AVE
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-1338
Mailing Address - Country:US
Mailing Address - Phone:248-302-9997
Mailing Address - Fax:
Practice Address - Street 1:13251 E 10 MILE RD STE 400
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48089-2000
Practice Address - Country:US
Practice Address - Phone:586-759-7474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-18
Last Update Date:2022-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501019919225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist