Provider Demographics
NPI:1073600458
Name:NICHOLAS, STEPHEN HOWARD (PT)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:HOWARD
Last Name:NICHOLAS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:101 LAGUNA RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-3636
Mailing Address - Country:US
Mailing Address - Phone:714-871-0460
Mailing Address - Fax:714-871-5342
Practice Address - Street 1:101 LAGUNA RD
Practice Address - Street 2:SUITE B
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3636
Practice Address - Country:US
Practice Address - Phone:714-871-0460
Practice Address - Fax:714-871-5342
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT5331225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAR37079Medicare UPIN