Provider Demographics
NPI:1932226651
Name:DOBRIN, NICOLE MARIE (PT, DPT, OCS)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:DOBRIN
Suffix:
Gender:F
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6024 RIDGE AVE # 237
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-1601
Mailing Address - Country:US
Mailing Address - Phone:215-262-3193
Mailing Address - Fax:
Practice Address - Street 1:20 E 11TH AVE
Practice Address - Street 2:
Practice Address - City:CONSHOHOCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428-1555
Practice Address - Country:US
Practice Address - Phone:610-828-7595
Practice Address - Fax:610-828-7505
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT018623225100000X
MD25159225100000X
HI3971225100000X
PADAPT001914225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA5773397OtherCIGNA-PPO
PA2822724000OtherIBC
PA11720725OtherCAQH
PA1950171OtherHIGHMARK BLUESHIELD
PA110079T8WMedicare PIN