Provider Demographics
NPI:1831166495
Name:NISBET, JOHN (PT)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:NISBET
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 PORTER DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1587
Mailing Address - Country:US
Mailing Address - Phone:925-838-1440
Mailing Address - Fax:
Practice Address - Street 1:200 PORTER DR
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1587
Practice Address - Country:US
Practice Address - Phone:925-838-1440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT6596225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PT65962Medicare PIN