MEDICARE: ROBERT MICHAEL NOSEK DPT

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	5303	SC
2	225100000X	Physical Therapist	2305206761	VA
3	2251X0800X	Orthopedic Physical Therapist	41299	CA

General Provider Information

NPI Number	:	1629143508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT MICHAEL NOSEK DPT

Provider Business Mailing Address
First Line	:	375 OLD STAGE CT
Second Line	:
City	:	FALLBROOK
State	:	CA
Zip	:	92028-4706
Country	:	US
Telephone Number	:	716-984-4726
Fax Number	:

Provider Business Practice Location Address
First Line	:	577 E ELDER ST
Second Line	:	SUITE I
City	:	FALLBROOK
State	:	CA
Zip	:	92028-3079
Country	:	US
Telephone Number	:	760-723-2687
Fax Number	:	760-723-2689

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

Provider Enumeration Date	:	11/23/2006
Last Update Date	:	03/30/2015

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