Provider Demographics
NPI:1710588116
Name:TSUTSUI, NICHOLAS KOSUKE (PT)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:KOSUKE
Last Name:TSUTSUI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7451 WARNER AVE STE A
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-8402
Mailing Address - Country:US
Mailing Address - Phone:714-596-0700
Mailing Address - Fax:714-596-0774
Practice Address - Street 1:7451 WARNER AVE STE A
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-8402
Practice Address - Country:US
Practice Address - Phone:714-596-0700
Practice Address - Fax:714-596-0774
Is Sole Proprietor?:No
Enumeration Date:2020-11-03
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT299058225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist