Provider Demographics
NPI:1124503503
Name:NARAYANAN, NANDU (DPT)
Entity type:Individual
Prefix:
First Name:NANDU
Middle Name:
Last Name:NARAYANAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:NANDU
Other - Middle Name:
Other - Last Name:N
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25629 LANE ST
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-2414
Mailing Address - Country:US
Mailing Address - Phone:909-665-6048
Mailing Address - Fax:
Practice Address - Street 1:25629 LANE ST
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-2414
Practice Address - Country:US
Practice Address - Phone:909-665-6048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-01
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27146225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist