Provider Demographics
NPI:1508301417
Name:VISEUR, NICOLE LINDSAY (DPT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:LINDSAY
Last Name:VISEUR
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 1:1582 W SAN MARCOS BLVD STE 105B
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-4081
Mailing Address - Country:US
Mailing Address - Phone:650-452-4110
Mailing Address - Fax:
Practice Address - Street 1:1020 TIERRA DEL REY STE A1
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-7886
Practice Address - Country:US
Practice Address - Phone:619-585-7104
Practice Address - Fax:619-585-7106
Is Sole Proprietor?:No
Enumeration Date:2016-12-31
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL0014380225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist