Healthcare Provider Details

I. General information

NPI: 1457231995
Provider Name (Legal Business Name): NICOLAS ROBERT ESCOBAR PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2025
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2079 ORANGE TREE LN
REDLANDS CA
92374-2849
US

IV. Provider business mailing address

31042 GRANITE ST
MENTONE CA
92359-1502
US

V. Phone/Fax

Practice location:
  • Phone: 909-353-7053
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number308747
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: