Provider Demographics
NPI:1740796242
Name:NICA PHYSICAL THERAPY, SPORT & REHAB
Entity type:Organization
Organization Name:NICA PHYSICAL THERAPY, SPORT & REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:NICASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:661-425-6441
Mailing Address - Street 1:25852 MCBEAN PKWY UNIT 863
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-2004
Mailing Address - Country:US
Mailing Address - Phone:661-425-6441
Mailing Address - Fax:
Practice Address - Street 1:25427 RYE CANYON RD
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-1206
Practice Address - Country:US
Practice Address - Phone:661-425-6441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-19
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy