Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Nicole Derue Physical Therapy PC

Organization Physical Therapy Clinic/Center · NPI 1053503185

Nicole Derue Physical Therapy PC is a Physical Therapy Clinic/Center in Central Square, New York. Licensed in New York. Registered with an NPI since 2007.

Licensed in
NY
In the registry since
2007
What do these letters mean?
PC — Professional corporation
A form of business registration, not a clinical qualification.

See every abbreviation used in this directory →

Practice location Address checks out

573 S Main St
Central Square, NY 13036-9785
Phone: (315) 676-3826
Fax: (315) 676-3402
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapy Clinic/Center (primary) Taxonomy 261QP2000X · Licence 0590998 (NY)

Record details

NPI number1053503185
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Nicole Derue — President · (315) 676-3826
Other names Fairway Physical Therapy North
NPI enumeratedAugust 13, 2007
Last updated in NPPESNovember 21, 2007
Mailing address573 S Main St, Central Square, NY 13036-9785