Provider Demographics
NPI:1336412923
Name:MONTELEONE, NADINE MARIE (PTA)
Entity Type:Individual
Prefix:
First Name:NADINE
Middle Name:MARIE
Last Name:MONTELEONE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21405 GLACIER DR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-1841
Mailing Address - Country:US
Mailing Address - Phone:586-598-8654
Mailing Address - Fax:
Practice Address - Street 1:13850 E 12 MILE RD
Practice Address - Street 2:SUITE 2A
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-3730
Practice Address - Country:US
Practice Address - Phone:586-445-3945
Practice Address - Fax:586-552-8310
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502003205225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant