Healthcare Provider Details

I. General information

NPI: 1760306583
Provider Name (Legal Business Name): NICHOLAS OCHOA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 5TH ST
BROOKINGS OR
97415-8329
US

IV. Provider business mailing address

3845 TEAKWOOD DR
LA PORTE TX
77571-4323
US

V. Phone/Fax

Practice location:
  • Phone: 541-469-7314
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2172438
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: