Provider Demographics
NPI:1255707618
Name:NG, NANCY (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:NG
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10785
Mailing Address - Street 2:
Mailing Address - City:ZEPHYR COVE
Mailing Address - State:NV
Mailing Address - Zip Code:89448-2785
Mailing Address - Country:US
Mailing Address - Phone:530-314-3249
Mailing Address - Fax:530-725-4500
Practice Address - Street 1:2877 LAKE TAHOE BLVD STE D
Practice Address - Street 2:
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-7807
Practice Address - Country:US
Practice Address - Phone:530-314-3249
Practice Address - Fax:530-725-4500
Is Sole Proprietor?:No
Enumeration Date:2015-08-19
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3020225100000X
CA41962225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist