Provider Demographics
NPI:1659826618
Name:MARRIOTT, NICOLA ELAINE (BSC (HONS))
Entity Type:Individual
Prefix:MRS
First Name:NICOLA
Middle Name:ELAINE
Last Name:MARRIOTT
Suffix:
Gender:F
Credentials:BSC (HONS)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 ROBLE DR
Mailing Address - Street 2:
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-5818
Mailing Address - Country:US
Mailing Address - Phone:408-772-5941
Mailing Address - Fax:
Practice Address - Street 1:820 ROBLE DR
Practice Address - Street 2:
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-5818
Practice Address - Country:US
Practice Address - Phone:408-772-5941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-19
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29335225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist