Healthcare Provider Details

I. General information

NPI: 1063349850
Provider Name (Legal Business Name): NICHOLAS ANTHONY CARDENAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 PARKMAN ST STE 127
BOSTON MA
02114-3117
US

IV. Provider business mailing address

245 SUMNER ST APT 403
BOSTON MA
02128-2193
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-2961
  • Fax:
Mailing address:
  • Phone: 603-897-9319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: