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General NPI Number Information
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NPI Number | 1265602601
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Entity Type | Individual
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Provider Name | NICOLE STACY BLACHER P.T.
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Gender | Female
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Dates
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Enumeration Date | 02/29/2008
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Last Update Date | 02/05/2016
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Provider Practice Location Address
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Address Line | 11777 SORRENTO VALLEY RD
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City | SAN DIEGO
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State | CA
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Zip | 92121-1084
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Country | US
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Telephone | 858-967-7701
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Fax |
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Provider Business Mailing Address
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Address Line | 4653 CARMEL MOUNTAIN RD STE 308-145
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City | SAN DIEGO
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State | CA
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Zip | 92130-6650
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Country | US
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Telephone | 858-967-7701
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | PT 18069
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License Number State | CA
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