Provider Demographics
NPI:1376218982
Name:RESTREPO, NICHOLAS (LPTA)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:RESTREPO
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 FALOR LN
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-2633
Mailing Address - Country:US
Mailing Address - Phone:540-808-5290
Mailing Address - Fax:
Practice Address - Street 1:3400 SOUTHPOINT DR
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-1261
Practice Address - Country:US
Practice Address - Phone:800-796-5420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306605964225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant