Provider Demographics
NPI:1770359341
Name:FISHEL, MIKAYLA NICOLE (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:MIKAYLA
Middle Name:NICOLE
Last Name:FISHEL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:MIKAYLA
Other - Middle Name:
Other - Last Name:BASIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:102 MADISON AVE FL 8
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-7584
Mailing Address - Country:US
Mailing Address - Phone:212-759-2282
Mailing Address - Fax:212-379-2123
Practice Address - Street 1:2465 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-0295
Practice Address - Country:US
Practice Address - Phone:646-829-2299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-27
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051203225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist