Provider Demographics
NPI:1528434289
Name:TADLER, NICOLE V (PT, DPT)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:V
Last Name:TADLER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:MISS
Other - First Name:NICOLE
Other - Middle Name:V
Other - Last Name:MASKERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:410 MALONEY RD
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921
Mailing Address - Country:US
Mailing Address - Phone:410-392-9400
Mailing Address - Fax:410-392-0577
Practice Address - Street 1:410 MALONEY RD
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921
Practice Address - Country:US
Practice Address - Phone:410-392-9400
Practice Address - Fax:410-392-0577
Is Sole Proprietor?:No
Enumeration Date:2015-08-18
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD28212225100000X
NJ40QA01620000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist