Provider Demographics
NPI:1285972588
Name:DEHNEY-CALLAHAN, NICOLE PATRICE (PT)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:PATRICE
Last Name:DEHNEY-CALLAHAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 RED SPRING LN
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-1743
Mailing Address - Country:US
Mailing Address - Phone:516-671-2797
Mailing Address - Fax:516-671-2797
Practice Address - Street 1:22 RED SPRING LN
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-1743
Practice Address - Country:US
Practice Address - Phone:516-671-2797
Practice Address - Fax:516-671-2797
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-21
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY16445-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist