Provider Demographics
NPI:1679124689
Name:MIKSINSKI, NICOLE K (DPT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:K
Last Name:MIKSINSKI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2734
Mailing Address - Street 2:
Mailing Address - City:AMAGANSETT
Mailing Address - State:NY
Mailing Address - Zip Code:11930-2734
Mailing Address - Country:US
Mailing Address - Phone:631-525-8345
Mailing Address - Fax:
Practice Address - Street 1:300 PANTIGO PL STE 112
Practice Address - Street 2:
Practice Address - City:EAST HAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11937-5927
Practice Address - Country:US
Practice Address - Phone:631-329-1828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044976225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist