Provider Demographics
NPI:1538397781
Name:NICOSIA, TONYA MARIE (MPT)
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:MARIE
Last Name:NICOSIA
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 VIENNE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-8945
Mailing Address - Country:US
Mailing Address - Phone:949-726-1634
Mailing Address - Fax:
Practice Address - Street 1:32 VIENNE
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-8945
Practice Address - Country:US
Practice Address - Phone:949-726-1634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-26
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25622225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist