Provider Demographics
NPI:1003866658
Name:SAN NICOLAS, JOEL T (PT)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:T
Last Name:SAN NICOLAS
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:PO BOX 549
Mailing Address - Street 2:
Mailing Address - City:NINE MILE FALLS
Mailing Address - State:WA
Mailing Address - Zip Code:99026-0549
Mailing Address - Country:US
Mailing Address - Phone:509-465-5663
Mailing Address - Fax:509-467-8663
Practice Address - Street 1:5928 HIGHWAY 291
Practice Address - Street 2:
Practice Address - City:NINE MILE FALLS
Practice Address - State:WA
Practice Address - Zip Code:99026-9525
Practice Address - Country:US
Practice Address - Phone:509-465-5663
Practice Address - Fax:509-467-8663
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00005032225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist