Provider Demographics
NPI:1881811321
Name:DETOMASO, NINAMARIE (MS,PT)
Entity type:Individual
Prefix:MS
First Name:NINAMARIE
Middle Name:
Last Name:DETOMASO
Suffix:
Gender:F
Credentials:MS,PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 TIMBER DR E
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-6925
Mailing Address - Country:US
Mailing Address - Phone:919-661-2085
Mailing Address - Fax:919-661-2085
Practice Address - Street 1:1400 TIMBER DR E
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-6925
Practice Address - Country:US
Practice Address - Phone:919-661-2085
Practice Address - Fax:919-661-2085
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10734225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist