Provider Demographics
NPI:1154132447
Name:DR NICOLE GARLIT PHYSICAL THERAPY AND WELLNESS INC
Entity type:Organization
Organization Name:DR NICOLE GARLIT PHYSICAL THERAPY AND WELLNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE ASHLEY
Authorized Official - Middle Name:MAPALO
Authorized Official - Last Name:GARLIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-596-3396
Mailing Address - Street 1:1611 SYCAMORE AVE UNIT 5098
Mailing Address - Street 2:
Mailing Address - City:HERCULES
Mailing Address - State:CA
Mailing Address - Zip Code:94547-6003
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3241 GRAND AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-2740
Practice Address - Country:US
Practice Address - Phone:707-596-3396
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty