Individual
NICHOLAS VIRDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T., DPT
Contact information
Practice address
1948 MESQUITE AVE, 101, LAKE HAVASU CITY, AZ 86403-5777
(928) 854-4776
Mailing address
1948 MESQUITE AVE, 101, LAKE HAVASU CITY, AZ 86403-5777
(928) 854-4776
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
12794
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12794
ARIZONA STATE LICENSE
—
Enumeration date
01/23/2017
Last updated
01/23/2017
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