Nichole Delisio, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

21336 Issued in MD

Practice address

9135 Piscataway Rd
Suite 305
Clinton, MD 20735-2549

Phone

(301) 877-2323

Fax

(301) 877-2366

NPI assigned

Nov 10, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Nichole Brake Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Active Physical Therapy Services, LLC

  • Physical Therapist
  • Laurel, MD
  • NPI 1225217334
  NPD (past)
• Frederick Health Hospital Inc

  dba Frederick Health Hospital

  • General Acute Care Hospital
  • Frederick, MD
  • NPI 1538165527
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1311033600000",
    "number": "1336210681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9093 RIDGEFIELD DR",
            "address_2": "S 201",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217016712",
            "telephone_number": "301-696-5595",
            "fax_number": "301-696-0842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9135 PISCATAWAY RD",
            "address_2": "SUITE 305",
            "city": "CLINTON",
            "state": "MD",
            "postal_code": "207352549",
            "telephone_number": "301-877-2323",
            "fax_number": "301-877-2366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DELISIO",
        "first_name": "NICHOLE",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-10",
        "last_updated": "2011-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MD",
            "license": "21336",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICHOLE",
            "last_name": "BRAKE",
            "credential": "PT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• DCPS
• Joshua Dearing, MD
• Jenny Dees, LGPC, NCC
• Lindsey Degeorge, MD
• Sheryl Punzal Deguzman-Buenaventura, NP
• Brittany Deloatch, NCC, LGPC
• Christopher Demas, PA
• Nicholas A Demonaco, M.D.
• Derek C. Ego-Osuala LLC (Excelsis root canal specialties)
• Tashida A. Deroux, MPT

• Physical Therapist in Clinton, MD
• Providers in Clinton, MD by specialty
• Physical Therapist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.