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General NPI Number Information
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NPI Number | 1912445891
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Entity Type | Individual
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Provider Name | MANDY NADER DPT
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Gender | Female
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Dates
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Enumeration Date | 02/10/2017
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Last Update Date | 02/10/2017
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Provider Practice Location Address
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Address Line | 2951 HARBOR BLVD
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City | COSTA MESA
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State | CA
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Zip | 92626-3912
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Country | US
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Telephone | 714-427-0803
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Fax |
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Provider Business Mailing Address
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Address Line | 6238 E CLIFFWAY DR
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City | ORANGE
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State | CA
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Zip | 92869-6001
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Country | US
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Telephone | 714-931-2472
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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 | PT291655
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License Number State | CA
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