Provider Demographics
NPI:1972836054
Name:PAGAN, NISHA (DPT, PT, NCS)
Entity Type:Individual
Prefix:
First Name:NISHA
Middle Name:
Last Name:PAGAN
Suffix:
Gender:F
Credentials:DPT, PT, NCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 ATLANTIC AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-2833
Mailing Address - Country:US
Mailing Address - Phone:562-281-7369
Mailing Address - Fax:562-296-4963
Practice Address - Street 1:4301 ATLANTIC AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-2833
Practice Address - Country:US
Practice Address - Phone:562-281-7369
Practice Address - Fax:562-296-4963
Is Sole Proprietor?:No
Enumeration Date:2009-09-08
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
CAPT290702251P0200X, 2251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology