Provider Demographics
NPI:1245458033
Name:NAKASE, NICOLA NATSUMI (DPT)
Entity type:Individual
Prefix:MS
First Name:NICOLA
Middle Name:NATSUMI
Last Name:NAKASE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2408 34TH ST.
Mailing Address - Street 2:7
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405
Mailing Address - Country:US
Mailing Address - Phone:310-664-6028
Mailing Address - Fax:
Practice Address - Street 1:130 E GRAND AVE
Practice Address - Street 2:F
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-3831
Practice Address - Country:US
Practice Address - Phone:310-333-0777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27493225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist