Provider Demographics
NPI:1023825734
Name:SEIM, NICHOLAS DAVID (PT, DPT)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:DAVID
Last Name:SEIM
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 N CENTRAL AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-3685
Mailing Address - Country:US
Mailing Address - Phone:310-480-2626
Mailing Address - Fax:
Practice Address - Street 1:1000 N CENTRAL AVE STE 110
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-3685
Practice Address - Country:US
Practice Address - Phone:310-480-2626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-16
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA307279225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist