Provider Demographics
NPI:1861174906
Name:PANIATI, NICHOLAS J (PT)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:J
Last Name:PANIATI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:482 E ALTAMONTE DR STE 1006
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-4604
Mailing Address - Country:US
Mailing Address - Phone:407-214-6333
Mailing Address - Fax:407-214-9011
Practice Address - Street 1:482 E ALTAMONTE DR STE 1006
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-4604
Practice Address - Country:US
Practice Address - Phone:407-214-6333
Practice Address - Fax:407-214-9011
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT40659225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist