Provider Demographics
NPI:1083628150
Name:BLOCK, NANCY (PT)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:BLOCK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 S DE ANZA BLVD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-5347
Mailing Address - Country:US
Mailing Address - Phone:408-257-2225
Mailing Address - Fax:408-257-2485
Practice Address - Street 1:1601 S DE ANZA BLVD
Practice Address - Street 2:SUITE 111
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-5347
Practice Address - Country:US
Practice Address - Phone:408-257-2225
Practice Address - Fax:408-257-2485
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT12580225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT12580OtherSTATE LICENSE
CAOPT125800Medicare ID - Type UnspecifiedMEDIARE NUMBER