Healthcare Provider Details

I. General information

NPI: 1114216975
Provider Name (Legal Business Name): NAKOA FITNESS AND PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2011
Last Update Date: 02/15/2023
Certification Date: 02/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6068 CORTE DEL CEDRO
CARLSBAD CA
92011-1514
US

IV. Provider business mailing address

6068 CORTE DEL CEDRO
CARLSBAD CA
92011-1514
US

V. Phone/Fax

Practice location:
  • Phone: 760-804-1700
  • Fax: 760-807-1780
Mailing address:
  • Phone: 760-804-1700
  • Fax: 760-807-1780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALLISON CHICO NELSON
Title or Position: PRACTICE DIRECTOR
Credential: DPT
Phone: 760-804-1700