Healthcare Provider Details

I. General information

NPI: 1801951652
Provider Name (Legal Business Name): MICHELLE K NOMURA MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 03/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39180 FARWELL DR. SUITE 101
FREMONT CA
94538
US

IV. Provider business mailing address

39810 FARWELL DR. SUITE 101
FREMONT CA
94538
US

V. Phone/Fax

Practice location:
  • Phone: 510-438-0294
  • Fax: 510-438-0468
Mailing address:
  • Phone: 510-438-0294
  • Fax: 510-438-0468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT22842
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: