MEDICARE: MRS. NICOLE JENNIFER REA MPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center	PT27082	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PT27082	OTHER	CA	STATE LICENSE NUMBER

General Provider Information

NPI Number	:	1013941046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NICOLE JENNIFER REA MPT

Provider Business Mailing Address
First Line	:	1187 COAST VILLAGE RD
Second Line	:	STE 8
City	:	MONTECITO
State	:	CA
Zip	:	93108-2762
Country	:	US
Telephone Number	:	805-565-5670
Fax Number	:	805-565-5690

Provider Business Practice Location Address
First Line	:	1187 COAST VILLAGE RD
Second Line	:	STE 8
City	:	MONTECITO
State	:	CA
Zip	:	93108-2762
Country	:	US
Telephone Number	:	805-565-5670
Fax Number	:	805-565-5690

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	02/11/2022

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