Provider Demographics
NPI:1568757839
Name:RHODES, NICOLLE YUKIE (PT, DPT, CSCS)
Entity type:Individual
Prefix:
First Name:NICOLLE
Middle Name:YUKIE
Last Name:RHODES
Suffix:
Gender:
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23026 GALVA AVE
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-3521
Mailing Address - Country:US
Mailing Address - Phone:310-418-9040
Mailing Address - Fax:
Practice Address - Street 1:500 S SEPULVEDA BLVD STE 106
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-6945
Practice Address - Country:US
Practice Address - Phone:424-247-9112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL-11240225100000X
CA400762251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist