Provider Demographics
NPI:1841321262
Name:PIAZZA, NICHOLAS BRIAN (PT)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:BRIAN
Last Name:PIAZZA
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 1:2600 STANWELL DRIVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-4863
Mailing Address - Country:US
Mailing Address - Phone:925-686-5400
Mailing Address - Fax:
Practice Address - Street 1:2600 STANWELL DRIVE
Practice Address - Street 2:SUITE 107
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-4863
Practice Address - Country:US
Practice Address - Phone:925-686-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28966225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR022693Medicaid