| Doctor Name: | NICOLE BASHAM |
| NPI Number: | 1245661164 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | DPT |
| License Number: | PT60408454 |
| Business Practice Address: | 2357 W March Ln Stockton, CA - 952075239 |
| Business Phone Number: | 2094779300 |
| Business Fax Number: | |
| Mailing Address: | 8557 Diamond Oak Way, ELK GROVE |
| State: | CA |
| Postal Code: | 956241749 |
| Phone Number: | 8587351753 |
| Fax Number: | |
| NPI Enumeration Date: | 12/03/2013 |
| NPI Last Update Date: | 03/26/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | PT60408454 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | WA |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |