Provider Demographics
NPI:1831410877
Name:SERGEANT, NICOLE ANGELA
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ANGELA
Last Name:SERGEANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 TAILGATE TER
Mailing Address - Street 2:
Mailing Address - City:LANDOVER
Mailing Address - State:MD
Mailing Address - Zip Code:20785-4796
Mailing Address - Country:US
Mailing Address - Phone:917-771-6007
Mailing Address - Fax:
Practice Address - Street 1:504 TAILGATE TER
Practice Address - Street 2:
Practice Address - City:LANDOVER
Practice Address - State:MD
Practice Address - Zip Code:20785-4796
Practice Address - Country:US
Practice Address - Phone:917-771-6007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-14
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPT871045225100000X
MD22911225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist