Provider Demographics
NPI:1053388140
Name:HAIDER, NICHOLAS JOHN (MPT PT)
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:JOHN
Last Name:HAIDER
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Gender:M
Credentials:MPT PT
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Mailing Address - Street 1:3809 PLAZA DR
Mailing Address - Street 2:STE 112
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-4625
Mailing Address - Country:US
Mailing Address - Phone:760-941-2630
Mailing Address - Fax:760-941-4617
Practice Address - Street 1:3809 PLAZA DR
Practice Address - Street 2:STE 112
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4625
Practice Address - Country:US
Practice Address - Phone:760-941-2630
Practice Address - Fax:760-941-4617
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-07
Last Update Date:2007-07-08
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT25678Medicare UPIN
CAWPT25678Medicare ID - Type Unspecified