Provider Demographics
NPI:1194367714
Name:AMARO, NICOLE M (PT, DPT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:M
Last Name:AMARO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:PATTISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2951 HARBOR BLVD
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-3912
Mailing Address - Country:US
Mailing Address - Phone:714-427-0803
Mailing Address - Fax:714-427-0785
Practice Address - Street 1:2951 HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-3912
Practice Address - Country:US
Practice Address - Phone:714-427-0803
Practice Address - Fax:714-427-0785
Is Sole Proprietor?:No
Enumeration Date:2019-10-15
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT2976172251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic