Provider Demographics
NPI:1235290461
Name:NIHAD, OTHMAN SAMI (PT,DC)
Entity Type:Individual
Prefix:DR
First Name:OTHMAN
Middle Name:SAMI
Last Name:NIHAD
Suffix:
Gender:M
Credentials:PT,DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 692077
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95269-2077
Mailing Address - Country:US
Mailing Address - Phone:209-956-5699
Mailing Address - Fax:209-956-5558
Practice Address - Street 1:1052 RIVARA RD
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-1824
Practice Address - Country:US
Practice Address - Phone:209-956-5699
Practice Address - Fax:209-956-5558
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC19233111NS0005X
CA00PT93850225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PT93850Medicare ID - Type Unspecified