Provider Demographics
NPI:1992570196
Name:YAMAMOTO, NICOLE (DPT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:YAMAMOTO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:NIKKI
Other - Middle Name:
Other - Last Name:YAMAMOTO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:2691 CALLE MORELIA
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-5777
Mailing Address - Country:US
Mailing Address - Phone:925-605-6529
Mailing Address - Fax:
Practice Address - Street 1:421 MILLER AVE
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-2903
Practice Address - Country:US
Practice Address - Phone:415-388-8166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-17
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA304790225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist