Provider Demographics
NPI:1508289596
Name:HARVEY, NICOLAS (MA, ATC)
Entity Type:Individual
Prefix:
First Name:NICOLAS
Middle Name:
Last Name:HARVEY
Suffix:
Gender:M
Credentials:MA, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 E COLTON AVE
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-3720
Mailing Address - Country:US
Mailing Address - Phone:909-748-8409
Mailing Address - Fax:
Practice Address - Street 1:1200 E COLTON AVE
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-3720
Practice Address - Country:US
Practice Address - Phone:909-748-8409
Practice Address - Fax:909-335-5139
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-27
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0608022082255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer