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General NPI Number Information
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NPI Number | 1740796242
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Entity Type | Organization
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Legal Business Name | NICA PHYSICAL THERAPY, SPORT & REHAB
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Dates
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Enumeration Date | 12/19/2017
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Last Update Date | 12/19/2017
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Provider Practice Location Address
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Address Line | 25427 RYE CANYON RD
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City | VALENCIA
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State | CA
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Zip | 91355-1206
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Country | US
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Telephone | 661-425-6441
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Fax |
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Provider Business Mailing Address
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Address Line | 25852 MCBEAN PKWY UNIT 863
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City | SANTA CLARITA
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State | CA
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Zip | 91355-2004
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Country | US
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Telephone | 661-425-6441
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JON NICASTRO
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Credential | DPT
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Telephone | 661-425-6441
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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