Provider Demographics
NPI:1427151760
Name:NICOLI, JANE MARIA (PT)
Entity type:Individual
Prefix:MS
First Name:JANE
Middle Name:MARIA
Last Name:NICOLI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:
Other - Last Name:NICOLI GEMLICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2195 CHEAT RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508
Mailing Address - Country:US
Mailing Address - Phone:304-594-2500
Mailing Address - Fax:304-594-9310
Practice Address - Street 1:2195 CHEAT RD.
Practice Address - Street 2:SUITE 1
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508
Practice Address - Country:US
Practice Address - Phone:304-594-2500
Practice Address - Fax:304-594-9310
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV001103225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV7302130000Medicaid
WV7302130000Medicaid