Provider Demographics
NPI:1245937739
Name:MESSINA, NICHOLAS (PT)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:
Last Name:MESSINA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 W TREMONT AVE APT 215
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-6672
Mailing Address - Country:US
Mailing Address - Phone:443-878-2093
Mailing Address - Fax:
Practice Address - Street 1:8943 S TRYON ST UNIT K
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-3539
Practice Address - Country:US
Practice Address - Phone:704-588-0885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-14
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD29332225100000X
VACP035191T225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist