MEDICARE: DR. MICHAEL JOSHUA NILSEN PT, 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	PT023811	PA

General Provider Information

NPI Number	:	1679982508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL JOSHUA NILSEN PT, DPT

Provider Business Mailing Address
First Line	:	49 IVANHOE DR
Second Line	:
City	:	MANALAPAN
State	:	NJ
Zip	:	07726-1715
Country	:	US
Telephone Number	:	732-598-1894
Fax Number	:

Provider Business Practice Location Address
First Line	:	1601 CHERRY ST
Second Line	:	MS 21041
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-1320
Country	:	US
Telephone Number	:	215-553-7012
Fax Number	:	215-553-7019

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

Provider Enumeration Date	:	08/05/2014
Last Update Date	:	08/08/2014

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