Provider Demographics
NPI:1043992944
Name:NOMADIC PHYSICAL THERAPY INC.
Entity type:Organization
Organization Name:NOMADIC PHYSICAL THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHARBONNET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-371-7212
Mailing Address - Street 1:11 NEW DAWN
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-1976
Mailing Address - Country:US
Mailing Address - Phone:714-371-7212
Mailing Address - Fax:
Practice Address - Street 1:11 NEW DAWN
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92620-1976
Practice Address - Country:US
Practice Address - Phone:714-371-7212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-01
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy