Provider Demographics
NPI:1922774744
Name:VAN HOORN, NICHOLAS BRUCE (DPT)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:BRUCE
Last Name:VAN HOORN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 PLACER DR
Mailing Address - Street 2:
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93117-1314
Mailing Address - Country:US
Mailing Address - Phone:805-259-8348
Mailing Address - Fax:760-918-9200
Practice Address - Street 1:3257 CAMINO DE LOS COCHES STE 301
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-8974
Practice Address - Country:US
Practice Address - Phone:760-652-5236
Practice Address - Fax:760-652-5134
Is Sole Proprietor?:No
Enumeration Date:2021-08-20
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300588225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA300588OtherPHYSICAL THERAPY LICENSE