Provider Demographics
NPI:1053592469
Name:CALVO, NIMPHANIDA (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:NIMPHANIDA
Middle Name:
Last Name:CALVO
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 BOLTEN PL
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-5505
Mailing Address - Country:US
Mailing Address - Phone:201-757-3473
Mailing Address - Fax:
Practice Address - Street 1:9 BOLTEN PL
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-5505
Practice Address - Country:US
Practice Address - Phone:201-757-3473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-14
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01010000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist