Provider Demographics
NPI:1760236822
Name:RABAT, NICHOLAS CAINE (DPT)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:CAINE
Last Name:RABAT
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 SPRING LAKE CRES APT 301
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-6420
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2404 POTTERS RD STE 400
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-4335
Practice Address - Country:US
Practice Address - Phone:757-961-5888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-15
Last Update Date:2024-12-03
Deactivation Date:2024-11-11
Deactivation Code:
Reactivation Date:2024-12-03
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA2305216823225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program