MEDICARE: MR. SCOTT NOSSEK PT, MS

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	1674	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	650008704	OTHER	AZ	MEDICARE RR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1Z6798	OTHER	AZ	HEALTH NET
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	DOL OWCP	OTHER	AZ	189208700
7	64-00187	OTHER	AZ	UNITED HEALTH PLAN
8	000227851	OTHER	AZ	AZ STATE DES CMDP

General Provider Information

NPI Number	:	1861495210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SCOTT NOSSEK PT, MS

Provider Business Mailing Address
First Line	:	405 W MAIN ST
Second Line	:	STE D
City	:	PAYSON
State	:	AZ
Zip	:	85541-5345
Country	:	US
Telephone Number	:	928-474-0429
Fax Number	:	928-474-0199

Provider Business Practice Location Address
First Line	:	405 W MAIN ST
Second Line	:	STE D
City	:	PAYSON
State	:	AZ
Zip	:	85541-5345
Country	:	US
Telephone Number	:	928-474-0429
Fax Number	:	928-474-0199

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	09/23/2010

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