Provider Demographics
NPI:1174508253
Name:NOSEK, MARY JOANN (PT)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:JOANN
Last Name:NOSEK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:26941 CABOT RD
Mailing Address - Street 2:STE 125
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653
Mailing Address - Country:US
Mailing Address - Phone:949-273-6766
Mailing Address - Fax:949-273-6765
Practice Address - Street 1:26941 CABOT RD STE 125
Practice Address - Street 2:NOSEK & ASSOCIATES PHYSICAL THERAPY INC
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653
Practice Address - Country:US
Practice Address - Phone:949-273-6766
Practice Address - Fax:949-273-6765
Is Sole Proprietor?:No
Enumeration Date:2005-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT233142251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT23314BMedicare ID - Type Unspecified
CAWPT23314AMedicare ID - Type Unspecified