Provider Demographics
NPI:1255341103
Name:DELLICOLLI, NICHOLAS (PT)
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:
Last Name:DELLICOLLI
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 1:501 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:BOW
Mailing Address - State:NH
Mailing Address - Zip Code:03304-3416
Mailing Address - Country:US
Mailing Address - Phone:603-224-5883
Mailing Address - Fax:603-224-6042
Practice Address - Street 1:501 SOUTH ST
Practice Address - Street 2:
Practice Address - City:BOW
Practice Address - State:NH
Practice Address - Zip Code:03304-3416
Practice Address - Country:US
Practice Address - Phone:603-224-5883
Practice Address - Fax:603-224-6042
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3057225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30393897Medicaid
NH30393897Medicaid