Provider Demographics
NPI:1184461196
Name:NICHOLS, KARINA LEA
Entity type:Individual
Prefix:
First Name:KARINA
Middle Name:LEA
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3878 W CARSON ST STE 101
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-6707
Mailing Address - Country:US
Mailing Address - Phone:310-316-8878
Mailing Address - Fax:
Practice Address - Street 1:3878 W CARSON ST STE 101
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-6707
Practice Address - Country:US
Practice Address - Phone:310-316-8878
Practice Address - Fax:310-316-8879
Is Sole Proprietor?:No
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA306244225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist