Individual
NICOLE HASTIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
4536 STATE ROUTE 212, WILLOW, NY 12495
(845) 706-2735
Mailing address
4536 STATE ROUTE 212, WILLOW, NY 12495
(845) 706-2735
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
004522-1
NY
Other
Enumeration date
11/19/2018
Last updated
11/19/2018
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