Provider Demographics
NPI:1740235985
Name:BARTON, NICOLAS (MPT)
Entity Type:Individual
Prefix:
First Name:NICOLAS
Middle Name:
Last Name:BARTON
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18000 PRAIRIE AVE
Mailing Address - Street 2:APT D
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-3738
Mailing Address - Country:US
Mailing Address - Phone:818-598-1426
Mailing Address - Fax:
Practice Address - Street 1:28720 ROADSIDE DR
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-3316
Practice Address - Country:US
Practice Address - Phone:818-575-9072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26103225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
W18877OtherPROVIDER ID#
W18877OtherPROVIDER ID#