Provider Demographics
NPI:1194943423
Name:NOSSEK REHAB LLC
Entity type:Organization
Organization Name:NOSSEK REHAB LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:J
Authorized Official - Last Name:NOSSEK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:928-474-0429
Mailing Address - Street 1:405 W MAIN ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:PAYSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85541-5333
Mailing Address - Country:US
Mailing Address - Phone:928-474-0429
Mailing Address - Fax:928-474-0199
Practice Address - Street 1:405 W MAIN ST
Practice Address - Street 2:SUITE D
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541-5333
Practice Address - Country:US
Practice Address - Phone:928-474-0429
Practice Address - Fax:928-474-0199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ225100000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ194960Medicaid
AZAZ-1730-1201OtherPTP
AZAZ0293830OtherBCBS
AZ64-00187OtherUHC
AZ670821OtherACN
AZ000227851OtherCMDP
AZ1004136OtherCIGNA
AZ670821OtherACN