Provider Demographics
NPI:1114607256
Name:COLETTI, NICHOLAS JAMES
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:JAMES
Last Name:COLETTI
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 ENGLISH TOWN LN APT 312
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-4680
Mailing Address - Country:US
Mailing Address - Phone:754-234-2738
Mailing Address - Fax:
Practice Address - Street 1:960 ENGLISH TOWN LN APT 312
Practice Address - Street 2:
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-4680
Practice Address - Country:US
Practice Address - Phone:754-234-2738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-24
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT40544225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist