Provider Demographics
NPI:1043447584
Name:KINNEY, NICOLE GABRIELLE (PT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:GABRIELLE
Last Name:KINNEY
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 1:7067 STATE ROUTE 42
Mailing Address - Street 2:
Mailing Address - City:WOODBOURNE
Mailing Address - State:NY
Mailing Address - Zip Code:12788-7318
Mailing Address - Country:US
Mailing Address - Phone:914-799-0061
Mailing Address - Fax:
Practice Address - Street 1:606 OLD ROUTE 17
Practice Address - Street 2:
Practice Address - City:MONTECELLO
Practice Address - State:NY
Practice Address - Zip Code:12701
Practice Address - Country:US
Practice Address - Phone:845-794-1400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-11
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017096225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist