Provider Demographics
NPI:1912471269
Name:BARBAGLIA, NICHOLAS AUGUSTINO (DPT)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:AUGUSTINO
Last Name:BARBAGLIA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3980 9TH AVE UNIT 208
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-3247
Mailing Address - Country:US
Mailing Address - Phone:314-757-7374
Mailing Address - Fax:
Practice Address - Street 1:8250 WOODMAN AVE
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-5427
Practice Address - Country:US
Practice Address - Phone:818-815-6049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-18
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT296075225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty