Provider Demographics
NPI:1801940432
Name:PINEDA NICOLAS, PAULA (PT)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:PINEDA NICOLAS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5520 PARK AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-3463
Mailing Address - Country:US
Mailing Address - Phone:203-368-1192
Mailing Address - Fax:203-371-0358
Practice Address - Street 1:5520 PARK AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-3463
Practice Address - Country:US
Practice Address - Phone:203-368-1192
Practice Address - Fax:203-371-0358
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist