Provider Demographics
NPI:1750672770
Name:NIEVES, ANNE (PTA)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:NIEVES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3153 N BETHEL AVE
Mailing Address - Street 2:
Mailing Address - City:SANGER
Mailing Address - State:CA
Mailing Address - Zip Code:93657-9389
Mailing Address - Country:US
Mailing Address - Phone:559-362-4747
Mailing Address - Fax:
Practice Address - Street 1:3153 N BETHEL AVE
Practice Address - Street 2:
Practice Address - City:SANGER
Practice Address - State:CA
Practice Address - Zip Code:93657-9389
Practice Address - Country:US
Practice Address - Phone:559-362-4747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT6830225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant