Provider Demographics
NPI:1891023859
Name:NICKERSON, KATHERINE LEVINE (PT)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:LEVINE
Last Name:NICKERSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:KATE
Other - Middle Name:
Other - Last Name:LEVINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:20823 STEVENS CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-2108
Mailing Address - Country:US
Mailing Address - Phone:408-833-3465
Mailing Address - Fax:408-440-0409
Practice Address - Street 1:20823 STEVENS CREEK BLVD
Practice Address - Street 2:SUITE #200
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-2108
Practice Address - Country:US
Practice Address - Phone:408-252-6076
Practice Address - Fax:408-252-1159
Is Sole Proprietor?:No
Enumeration Date:2009-12-02
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17070225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist