Healthcare Provider Details

I. General information

NPI: 1194943423
Provider Name (Legal Business Name): NOSSEK REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 W MAIN ST SUITE D
PAYSON AZ
85541-5333
US

IV. Provider business mailing address

405 W MAIN ST SUITE D
PAYSON AZ
85541-5333
US

V. Phone/Fax

Practice location:
  • Phone: 928-474-0429
  • Fax: 928-474-0199
Mailing address:
  • Phone: 928-474-0429
  • Fax: 928-474-0199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateAZ

VIII. Authorized Official

Name: MR. SCOTT J NOSSEK
Title or Position: OWNER
Credential: PT
Phone: 928-474-0429