Provider Demographics
NPI:1154787224
Name:INDART, NICOLE
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:INDART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3717 MT DIABLO BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-3588
Mailing Address - Country:US
Mailing Address - Phone:925-284-5300
Mailing Address - Fax:925-284-5381
Practice Address - Street 1:3717 MT DIABLO BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-3588
Practice Address - Country:US
Practice Address - Phone:925-284-5300
Practice Address - Fax:925-284-5381
Is Sole Proprietor?:No
Enumeration Date:2016-01-05
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT242742251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT24274OtherPT LICENSE