Active NPI
Nicole Donnelly, MPT
- Physical Therapist
- Southampton, PA
National Provider Identifier
1073665543
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT017008
- Practice address
- 1111 Street Rd
Southampton, PA 18966-4250 - Phone
- (215) 675-4466
- Fax
- (215) 675-3711
- NPI assigned
- Jan 17, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT017008 | PA | Primary |
Addresses
Primary practice location
1111 Street Rd
Southampton, PA 18966-4250
Mailing address
2539 Fernwood Ave
Roslyn, PA 19001-3002
Phone (215) 887-5859
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT017008 | PA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168992000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1073665543",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2539 FERNWOOD AVE",
"city": "ROSLYN",
"state": "PA",
"postal_code": "190013002",
"telephone_number": "215-887-5859"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1111 STREET RD",
"city": "SOUTHAMPTON",
"state": "PA",
"postal_code": "189664250",
"telephone_number": "215-675-4466",
"fax_number": "215-675-3711"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DONNELLY",
"first_name": "NICOLE",
"credential": "MPT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-17",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "PA",
"license": "PT017008",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Southampton, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.