MEDICARE: DR. NICHOLAS RYAN FELIPE PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	39079	CA

General Provider Information

NPI Number	:	1891552501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICHOLAS RYAN FELIPE PT, DPT

Provider Business Mailing Address
First Line	:	4956 CASTANA AVE APT 32
Second Line	:
City	:	LAKEWOOD
State	:	CA
Zip	:	90712-8004
Country	:	US
Telephone Number	:	562-754-0714
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 BELLEFONTAINE ST
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91105-3102
Country	:	US
Telephone Number	:	626-793-5114
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/29/2024
Last Update Date	:	02/29/2024

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