Provider Demographics
NPI:1417836578
Name:LASLEY, NICHOLAS JR (DPT)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:LASLEY
Suffix:JR
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:NICHOLAS
Other - Middle Name:
Other - Last Name:MARSHALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2 PETERS CANYON RD STE 100
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-1798
Mailing Address - Country:US
Mailing Address - Phone:949-679-3988
Mailing Address - Fax:949-679-7665
Practice Address - Street 1:29920 HUNTER RD STE 102
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-2764
Practice Address - Country:US
Practice Address - Phone:951-417-8195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-01
Last Update Date:2025-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA308687225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist