Provider Demographics
NPI:1174595854
Name:NICOLETTI, KIM JANETTE (PT)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:JANETTE
Last Name:NICOLETTI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:JANNETTE
Other - Last Name:ISAACSON-NICOLETTI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHYSICAL THERAPIST
Mailing Address - Street 1:2255 W GERMANN RD APT 2170
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-7281
Mailing Address - Country:US
Mailing Address - Phone:602-538-8674
Mailing Address - Fax:
Practice Address - Street 1:2255 W GERMANN RD APT 2170
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-7281
Practice Address - Country:US
Practice Address - Phone:203-313-7403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1254899225100000X
AZ13649225100000X
NY008973225100000X
CT004129225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist