Provider Demographics
NPI:1841224011
Name:LOSEE, NICKOLA (PT)
Entity Type:Individual
Prefix:
First Name:NICKOLA
Middle Name:
Last Name:LOSEE
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 1:1175 DARLENE DR
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-3503
Mailing Address - Country:US
Mailing Address - Phone:831-247-0029
Mailing Address - Fax:
Practice Address - Street 1:4615 SCOTTS VALLEY DR
Practice Address - Street 2:SUITE D
Practice Address - City:SCOTTS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95066-4278
Practice Address - Country:US
Practice Address - Phone:831-438-4478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32439225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist