Provider Demographics
NPI:1003707571
Name:BOLOGNO, NICK ANGELO (LMT)
Entity type:Individual
Prefix:
First Name:NICK
Middle Name:ANGELO
Last Name:BOLOGNO
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 8TH AVE SW # 5B
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-3606
Mailing Address - Country:US
Mailing Address - Phone:727-210-5941
Mailing Address - Fax:
Practice Address - Street 1:152 8TH AVE SW # 5B
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-3606
Practice Address - Country:US
Practice Address - Phone:727-210-5941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-14
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA95602225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist