Provider Demographics
NPI:1356883730
Name:DEMILT, NANCY
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:DEMILT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2299 RIM RD
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92264-4931
Mailing Address - Country:US
Mailing Address - Phone:631-463-8321
Mailing Address - Fax:
Practice Address - Street 1:2299 RIM RD
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92264-4931
Practice Address - Country:US
Practice Address - Phone:631-463-8321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-16
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013780-1225100000X
CAPT298923225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist