| Dr Nicholas A Detrick, DPT | |
|
1100 Wilford Hall Loop Bldg 4554, Jbsa Lackland, TX 78236-5638 | |
| (210) 292-7395 | |
| Not Available |
| Full Name | Dr Nicholas A Detrick |
|---|---|
| Gender | Male |
| Speciality | Physical Therapist |
| Location | 1100 Wilford Hall Loop Bldg 4554, Jbsa Lackland, Texas |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306360797 | NPI | - | NPPES |
| 1306360797 | Other | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 225100000X | Physical Therapist | 293415 (California) | Primary |
| Provider Name | Southern California Permanente Medical Group |
|---|---|
| Provider Type | Part B Supplier - Clinic/group Practice |
| Provider Identifiers | NPI Number: 1770515280 PECOS PAC ID: 6002729175 Enrollment ID: O20031110000678 |
| Provider Name | California Luna Care Physical Therapy Pc |
|---|---|
| Provider Type | Part B Supplier - Physical/occupational Therapy Group In Private Practice |
| Provider Identifiers | NPI Number: 1689162166 PECOS PAC ID: 9638427834 Enrollment ID: O20180803002123 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Nicholas A Detrick, DPT 1100 Wilford Hall Loop Bldg 4554, Jbsa Lackland, TX 78236-5638 Ph: (210) 292-7395 | Dr Nicholas A Detrick, DPT 1100 Wilford Hall Loop Bldg 4554, Jbsa Lackland, TX 78236-5638 Ph: (210) 292-7395 |
Dr. Jared Philip Bueche, PT, DPT, OCS, FAAOMP Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 1100 Wilford Hall Loop Bldg 4554, Jbsa Lackland, TX 78236 Phone: 210-292-5040 | |
Ramiro Alexander Garrido, PT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 1100 Wilford Hall Loop Bldg 4554, Jbsa Lackland, TX 78236 Phone: 210-292-7964 | |
Gillian Marie Harper, PT, DPT, OCS Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 1100 Wilford Hall Loop, Jbsa Lackland, TX 78236 Phone: 210-292-5040 | |
Brandi M Brinkman, Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 1100 Wilford Hall Loop, Jbsa Lackland, TX 78236 Phone: 210-292-4277 | |
Dr. Kassidy M Kusak, PT Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 1100 Wilford Hall Loop Bldg 4554, Jbsa Lackland, TX 78236 Phone: 210-566-9995 | |
Mr. Jeremiah Yanga Samson, PT, MSPT, OCS, COMT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 1100 Wilford Hall Loop Bldg 4554, Jbsa Lackland, TX 78236 Phone: 210-292-5040 | |
Allison Shea Gonzales, PT, DPT Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 1100 Wilford Hall Loop Bldg 4554, Jbsa Lackland, TX 78236 Phone: 210-292-6255 Fax: 210-292-7934 |