Provider Demographics
NPI:1437302791
Name:REISS, NICOLE (PT)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:
Last Name:REISS
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 1:1483 SUTTER ST
Mailing Address - Street 2:APT. 718
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-5476
Mailing Address - Country:US
Mailing Address - Phone:650-491-3416
Mailing Address - Fax:
Practice Address - Street 1:3401 TARAVAL ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94116-2050
Practice Address - Country:US
Practice Address - Phone:415-682-9902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-30
Last Update Date:2021-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34889225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist