Provider Demographics
NPI:1609639517
Name:NOLAZCO, SAUL (DPT)
Entity Type:Individual
Prefix:
First Name:SAUL
Middle Name:
Last Name:NOLAZCO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 TOWNE CTR APT 1007
Mailing Address - Street 2:
Mailing Address - City:CLIFFSIDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010-2056
Mailing Address - Country:US
Mailing Address - Phone:201-840-4063
Mailing Address - Fax:
Practice Address - Street 1:1 TOWNE CTR APT 1007
Practice Address - Street 2:
Practice Address - City:CLIFFSIDE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07010-2056
Practice Address - Country:US
Practice Address - Phone:201-988-0796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-02
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02241200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist