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Individual

MR. NICHOLAS C ANDERSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PTA

Contact information

Practice address
1700 KEYSTONE PACIFIC PKWY, PATTERSON, CA 95363-8874
(209) 895-4206
Mailing address
1518 COFFEE RD, MODESTO, CA 95355-3164
(209) 622-4387

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA50433
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
PTA50433
PTA
CA
Enumeration date
01/02/2020
Last updated
01/02/2020
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