Provider Demographics
NPI:1578594164
Name:FOX, NICOLE ANDREA (MPT)
Entity Type:Individual
Prefix:MISS
First Name:NICOLE
Middle Name:ANDREA
Last Name:FOX
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:7485 MISSION VALLEY RD
Mailing Address - Street 2:SUITE 104-A
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-4422
Mailing Address - Country:US
Mailing Address - Phone:619-291-8930
Mailing Address - Fax:619-291-8491
Practice Address - Street 1:7485 MISSION VALLEY RD
Practice Address - Street 2:SUITE 104-A
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4422
Practice Address - Country:US
Practice Address - Phone:619-291-8930
Practice Address - Fax:619-291-8491
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT29493225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW1762Medicare ID - Type Unspecified