Provider Demographics
NPI:1770679441
Name:NYSTROM, JANET N (PT)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:N
Last Name:NYSTROM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5980 STONERIDGE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-2723
Mailing Address - Country:US
Mailing Address - Phone:925-847-8833
Mailing Address - Fax:925-847-8772
Practice Address - Street 1:5980 STONERIDGE DR STE 100
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-2723
Practice Address - Country:US
Practice Address - Phone:925-847-8833
Practice Address - Fax:925-847-8772
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT12999225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist