Provider Demographics
NPI:1609237510
Name:NICOLO, JO-ANN GONZALES (PT ASSISSTANT)
Entity Type:Individual
Prefix:
First Name:JO-ANN
Middle Name:GONZALES
Last Name:NICOLO
Suffix:
Gender:F
Credentials:PT ASSISSTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6602 RUTLAND WAY
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93307-8821
Mailing Address - Country:US
Mailing Address - Phone:213-550-9296
Mailing Address - Fax:
Practice Address - Street 1:5300 WOODMERE DR STE 105
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93313-2797
Practice Address - Country:US
Practice Address - Phone:213-550-9296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-19
Last Update Date:2016-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT8586225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant