Provider Demographics
NPI:1902154792
Name:NICOLOSI, JESSICA (MPT, NCS)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:NICOLOSI
Suffix:
Gender:F
Credentials:MPT, NCS
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:J
Other - Last Name:SLAVEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:380 EMPIRE RD STE 230
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-2677
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:380 EMPIRE RC. STE. 230
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-6649
Practice Address - Country:US
Practice Address - Phone:720-890-1091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-27
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL-9401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist