Healthcare Provider Details

I. General information

NPI: 1235647199
Provider Name (Legal Business Name): BAILEY NICOLE RINICKER DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2018
Last Update Date: 01/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 L ST
CHULA VISTA CA
91911-1066
US

IV. Provider business mailing address

1225 ESSEX ST
SAN DIEGO CA
92103-3305
US

V. Phone/Fax

Practice location:
  • Phone: 619-271-7100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number294115
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: