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General NPI Number Information
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NPI Number | 1205158177
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Entity Type | Organization
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Legal Business Name | JOHN J NICOSIA INC
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Dates
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Enumeration Date | 02/19/2010
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Last Update Date | 06/09/2010
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Provider Practice Location Address
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Address Line | 22930 CRENSHAW BLVD SUITE F
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City | TORRANCE
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State | CA
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Zip | 90505-3048
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Country | US
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Telephone | 310-325-6940
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Fax | 310-325-6973
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Provider Business Mailing Address
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Address Line | 22930 CRENSHAW BLVD SUITE F
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City | TORRANCE
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State | CA
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Zip | 90505-3048
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Country | US
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Telephone | 310-325-6940
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Fax | 310-325-6973
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Authorized Official
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Title or Position | OWNER
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Name | MR. JOHN J NICOSIA
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Credential | RPT
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Telephone | 310-325-6940
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT2431
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License Number State | CA
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