MEDICARE: JOSHUA NIESEN PT

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	13325	AZ

General Provider Information

NPI Number	:	1942719547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSHUA NIESEN PT

Provider Business Mailing Address
First Line	:	15410 S MOUNTAIN PKWY STE 112
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85044-6691
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13967 W GRAND AVE # C-100
Second Line	:
City	:	SURPRISE
State	:	AZ
Zip	:	85374-3732
Country	:	US
Telephone Number	:	623-474-3952
Fax Number	:

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

Provider Enumeration Date	:	09/26/2017
Last Update Date	:	09/26/2017

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Directions to “ JOSHUA NIESEN PT” Practice Location

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