Provider Demographics
NPI:1932867546
Name:NETTLES, RASHID DION
Entity Type:Individual
Prefix:
First Name:RASHID
Middle Name:DION
Last Name:NETTLES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 ADAM CLAYTON POWELL JR BLVD APT 2C148TH
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10039-3542
Mailing Address - Country:US
Mailing Address - Phone:212-690-0441
Mailing Address - Fax:
Practice Address - Street 1:2550 ADAM CLAYTON POWELL JR BLVD APT 2C148TH
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10039-3542
Practice Address - Country:US
Practice Address - Phone:212-690-0441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032644225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty