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General NPI Number Information
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NPI Number | 1518846856
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Entity Type | Individual
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Provider Name | NICOLE WOSTBROCK PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 08/30/2025
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Last Update Date | 08/30/2025
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Provider Practice Location Address
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Address Line | 9215 CAUSEWAY BLVD
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City | TAMPA
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State | FL
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Zip | 33619-6608
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Country | US
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Telephone | 727-417-0107
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Fax |
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Provider Business Mailing Address
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Address Line | 12448 92ND TER
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City | SEMINOLE
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State | FL
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Zip | 33772-3213
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Country | US
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Telephone | 727-417-0107
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 43716
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License Number State | FL
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