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General NPI Number Information
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NPI Number | 1083905277
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Entity Type | Organization
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Legal Business Name | JEFF NICHOLL PHYSICAL THERAPY & SPORTS REHABILITATION, INC.
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Dates
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Enumeration Date | 04/22/2011
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Last Update Date | 04/22/2011
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Provider Practice Location Address
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Address Line | 516 LAS POSAS RD
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City | CAMARILLO
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State | CA
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Zip | 93010-5705
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Country | US
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Telephone | 805-388-5678
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Fax | 805-388-5665
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Provider Business Mailing Address
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Address Line | PO BOX 3783
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City | VENTURA
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State | CA
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Zip | 93006-3783
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Country | US
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Telephone | 805-388-5678
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Fax | 805-388-5665
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | JEFF NICHOLL
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Credential |
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Telephone | 805-388-5678
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 17739
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License Number State | CA
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