Provider Demographics
NPI:1538435458
Name:BALI-KEYES, NIKOLETTA A (PT)
Entity type:Individual
Prefix:
First Name:NIKOLETTA
Middle Name:A
Last Name:BALI-KEYES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 SCHIEFFELIN AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-5605
Mailing Address - Country:US
Mailing Address - Phone:718-654-6377
Mailing Address - Fax:
Practice Address - Street 1:1925 SCHIEFFELIN AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-5605
Practice Address - Country:US
Practice Address - Phone:718-654-6377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-25
Last Update Date:2012-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028058225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist