Provider Demographics
NPI:1710904420
Name:NICOLAI, NATASHA L (DPT)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:L
Last Name:NICOLAI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5297A COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94618-1462
Mailing Address - Country:US
Mailing Address - Phone:510-547-1630
Mailing Address - Fax:510-923-1944
Practice Address - Street 1:5297A COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94618-1462
Practice Address - Country:US
Practice Address - Phone:510-547-1630
Practice Address - Fax:510-923-1944
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00010166225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist