Provider Demographics
NPI:1811101983
Name:NICOLETTI, WILLIAM (PTA)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:NICOLETTI
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 MAPLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-4216
Mailing Address - Country:US
Mailing Address - Phone:412-856-7756
Mailing Address - Fax:
Practice Address - Street 1:911 LIGONIER ST STE 001
Practice Address - Street 2:
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-1843
Practice Address - Country:US
Practice Address - Phone:724-537-9577
Practice Address - Fax:724-537-0195
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE002237L225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant