Healthcare Provider Details

I. General information

NPI: 1194840314
Provider Name (Legal Business Name): NORBERT CHARLES NITSCH III PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 10/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2067 W VISTA WAY STE 185
VISTA CA
92083-6031
US

IV. Provider business mailing address

600 S ANDREASEN DR STE C
ESCONDIDO CA
92029-1917
US

V. Phone/Fax

Practice location:
  • Phone: 760-631-5888
  • Fax: 760-631-5880
Mailing address:
  • Phone: 760-591-7750
  • Fax: 760-294-9813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number33762
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: