Provider Demographics
NPI:1164824629
Name:VITTORIO, NICOLE (PT, DPT,)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:VITTORIO
Suffix:
Gender:F
Credentials:PT, DPT,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5214 E LOS ALTOS PLZ
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-4251
Mailing Address - Country:US
Mailing Address - Phone:562-597-3035
Mailing Address - Fax:
Practice Address - Street 1:5214 E LOS ALTOS PLZ
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815
Practice Address - Country:US
Practice Address - Phone:562-597-3035
Practice Address - Fax:562-597-3055
Is Sole Proprietor?:No
Enumeration Date:2014-09-16
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41617225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist