Provider Demographics
NPI:1528615747
Name:NICOLETTA, KATELYN (PT, DPT)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:NICOLETTA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 CARTHAGE ST
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-8984
Mailing Address - Country:US
Mailing Address - Phone:919-776-5488
Mailing Address - Fax:
Practice Address - Street 1:202 DAVIS GROVE CIR STE 107
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-2521
Practice Address - Country:US
Practice Address - Phone:919-303-5478
Practice Address - Fax:919-303-5468
Is Sole Proprietor?:No
Enumeration Date:2019-08-22
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP18706225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist