Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 32495 | CA |
NPI | 1013127133 |
---|---|
Provider Name | Mr. Chad J Nicholson |
First Address | Orange, CA 92868-1505 |
Second Address | Orange, CA 92868-1505 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2007 |
Last Update Date | 01/12/2021 |