Provider Demographics
NPI:1669202230
Name:WEISSMAN, NICOLE (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:WEISSMAN
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 1:6110 REESE RD APT 313
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-1249
Mailing Address - Country:US
Mailing Address - Phone:954-242-6564
Mailing Address - Fax:
Practice Address - Street 1:18355 NW 57TH AVE STE 104
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-2309
Practice Address - Country:US
Practice Address - Phone:305-910-2789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT41975225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist