Provider Demographics
NPI:1679653059
Name:COX, NANCY SMITH
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:SMITH
Last Name:COX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9089 CLAIREMONT MESA BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1225
Mailing Address - Country:US
Mailing Address - Phone:800-787-6787
Mailing Address - Fax:866-401-4170
Practice Address - Street 1:9089 CLAIREMONT MESA BLVD STE 200
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1225
Practice Address - Country:US
Practice Address - Phone:800-787-6787
Practice Address - Fax:866-401-4170
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2015-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT12593225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ02708ZOtherBLUE SHIELD
CAWPT12593AOtherMEDICARE PTAN#