Provider Demographics
NPI:1225383987
Name:VIADO, NICOLE B (PT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:B
Last Name:VIADO
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 1:421 W BROADWAY
Mailing Address - Street 2:APT 3148
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-9407
Mailing Address - Country:US
Mailing Address - Phone:714-206-7938
Mailing Address - Fax:
Practice Address - Street 1:421 W BROADWAY
Practice Address - Street 2:APT 3148
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-9407
Practice Address - Country:US
Practice Address - Phone:714-206-7938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39172225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist