Provider Demographics
NPI:1902992464
Name:NISHIJIMA, RANDALL L (PT)
Entity Type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:L
Last Name:NISHIJIMA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-3256
Mailing Address - Country:US
Mailing Address - Phone:408-379-3021
Mailing Address - Fax:408-271-5042
Practice Address - Street 1:280 JACKSON ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-3256
Practice Address - Country:US
Practice Address - Phone:408-379-3021
Practice Address - Fax:408-271-5042
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT16652225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist