Provider Demographics
NPI:1104443167
Name:FRUCHTER, NADINE (PT)
Entity type:Individual
Prefix:
First Name:NADINE
Middle Name:
Last Name:FRUCHTER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 LA LINDA DR
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-3305
Mailing Address - Country:US
Mailing Address - Phone:562-833-8681
Mailing Address - Fax:
Practice Address - Street 1:35 LA LINDA DR
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-3305
Practice Address - Country:US
Practice Address - Phone:562-833-8681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-25
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT252962251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics