Healthcare Provider Details

I. General information

NPI: 1649835307
Provider Name (Legal Business Name): CARRIE MICHELLE NOFZIGER PTA, B.A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2019
Last Update Date: 05/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7601 IMPERIAL HWY
DOWNEY CA
90242-3456
US

IV. Provider business mailing address

6362 TRINETTE AVE
GARDEN GROVE CA
92845-2839
US

V. Phone/Fax

Practice location:
  • Phone: 562-385-6239
  • Fax:
Mailing address:
  • Phone: 562-260-9214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License NumberAT6760
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: