Provider Demographics
NPI:1497063846
Name:NICHOLAS, NADYA YASMINA (DPT)
Entity Type:Individual
Prefix:
First Name:NADYA
Middle Name:YASMINA
Last Name:NICHOLAS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 N NASH ST STE 306
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-2850
Mailing Address - Country:US
Mailing Address - Phone:310-535-0008
Mailing Address - Fax:
Practice Address - Street 1:615 N NASH ST STE 306
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-2850
Practice Address - Country:US
Practice Address - Phone:310-535-0008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-20
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36910225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist