| Doctor Name: | NICHOLAS JOHN NELSON HENDERSON |
| NPI Number: | 1740518091 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | P.T. |
| License Number: | PT 36249 |
| Business Practice Address: | 26302 La Paz Rd Ste 105 Mission Viejo, CA - 926915313 |
| Business Phone Number: | 9492061700 |
| Business Fax Number: | 9492061800 |
| Mailing Address: | 200 Newport Center Dr, #213 NEWPORT BEACH |
| State: | CA |
| Postal Code: | 926607501 |
| Phone Number: | 9496441322 |
| Fax Number: | 9496440316 |
| NPI Enumeration Date: | 11/25/2009 |
| NPI Last Update Date: | 05/10/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | PT 36249 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| 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 |