MEDICARE: JUSTIN NESSEL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT36024	FL

General Provider Information

NPI Number	:	1447860044
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIN NESSEL

Provider Business Mailing Address
First Line	:	405 S 7TH ST
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-8322
Country	:	US
Telephone Number	:	772-460-2520
Fax Number	:

Provider Business Practice Location Address
First Line	:	405 S 7TH ST
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-8322
Country	:	US
Telephone Number	:	772-460-2520
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2020
Last Update Date	:	08/07/2020

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Directions to “ JUSTIN NESSEL ” Practice Location

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