Healthcare Provider Details

I. General information

NPI: 1730651209
Provider Name (Legal Business Name): FUMIKO K NOTTINGHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2018
Last Update Date: 12/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 SALEM DR
REDLANDS CA
92373-6147
US

IV. Provider business mailing address

4560 SE INTERNATIONAL WAY, STE 100,
MILWAUKIE OR
97222
US

V. Phone/Fax

Practice location:
  • Phone: 909-793-1233
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA49183
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: