Healthcare Provider Details

I. General information

NPI: 1902876501
Provider Name (Legal Business Name): NANNETTE MARIA PACO P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: NANNETTE MARIA PACO P.T.

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNITED STATES NAVAL HOSPITAL PSC 482
FPO AP
96362
US

IV. Provider business mailing address

PSC 482 BOX 3059
FPO AP
96362
US

V. Phone/Fax

Practice location:
  • Phone: 01181311437555
  • Fax:
Mailing address:
  • Phone: 011816117437555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number19579
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: