Basic Information
| Provider Information | |||||||||
| NPI: | 1841321262 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PIAZZA | ||||||||
| FirstName: | NICHOLAS | ||||||||
| MiddleName: | BRIAN | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2600 STANWELL DRIVE | ||||||||
| Address2: | SUITE 107 | ||||||||
| City: | CONCORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945204863 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9256865400 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2600 STANWELL DRIVE | ||||||||
| Address2: | SUITE 107 | ||||||||
| City: | CONCORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945204863 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9256865400 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2007 | ||||||||
| LastUpdateDate: | 04/04/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 28966 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 022693 | 05 | OR | MEDICAID |