Individual
SHAUN NIETO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
517 S A ST, 517 S A ST, MADERA, CA 93638
(559) 673-9228
Mailing address
4539 HILLSIDE RD, MADERA, CA 93636-8013
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
50075
CA
Other
Enumeration date
01/31/2023
Last updated
01/31/2023
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