Healthcare Provider Details

I. General information

NPI: 1417836578
Provider Name (Legal Business Name): NICHOLAS LASLEY JR. DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2025
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29920 HUNTER RD STE 102
MURRIETA CA
92563-2764
US

IV. Provider business mailing address

2 PETERS CANYON RD STE 100
IRVINE CA
92606-1798
US

V. Phone/Fax

Practice location:
  • Phone: 951-417-8195
  • Fax:
Mailing address:
  • Phone: 949-679-3988
  • Fax: 949-679-7665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number308687
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: