Provider Demographics
NPI:1154768133
Name:ROY, NICOLE (PT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:ROY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:RIPPENTROP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:5050 EL CAMINO REAL
Mailing Address - Street 2:210
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1530
Mailing Address - Country:US
Mailing Address - Phone:650-559-0011
Mailing Address - Fax:650-559-0012
Practice Address - Street 1:5050 EL CAMINO REAL
Practice Address - Street 2:210
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94022-1530
Practice Address - Country:US
Practice Address - Phone:650-559-0011
Practice Address - Fax:650-559-0012
Is Sole Proprietor?:No
Enumeration Date:2013-05-30
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39563225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA39563OtherPT LICENSE