Provider Demographics
NPI:1063949188
Name:NICKERSON, RENEE (PT,DPT)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:NICKERSON
Suffix:
Gender:F
Credentials:PT,DPT
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:
Other - Last Name:DELANEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:143 RAYMOND RD
Mailing Address - Street 2:
Mailing Address - City:CANDIA
Mailing Address - State:NH
Mailing Address - Zip Code:03034-2133
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:143 RAYMOND RD
Practice Address - Street 2:
Practice Address - City:CANDIA
Practice Address - State:NH
Practice Address - Zip Code:03034-2133
Practice Address - Country:US
Practice Address - Phone:603-483-3355
Practice Address - Fax:603-483-3357
Is Sole Proprietor?:No
Enumeration Date:2017-05-19
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist