Provider Demographics
NPI:1770315913
Name:HUNTLEY, NOLIN PATRICK
Entity type:Individual
Prefix:
First Name:NOLIN
Middle Name:PATRICK
Last Name:HUNTLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 163
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:NY
Mailing Address - Zip Code:12887-0163
Mailing Address - Country:US
Mailing Address - Phone:518-538-0896
Mailing Address - Fax:518-926-2020
Practice Address - Street 1:1134 STATE ROUTE 29
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:NY
Practice Address - Zip Code:12834-6107
Practice Address - Country:US
Practice Address - Phone:518-692-9861
Practice Address - Fax:518-692-7947
Is Sole Proprietor?:No
Enumeration Date:2024-08-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052797225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist