Provider Demographics
NPI:1437240645
Name:NOSBISCH, TIMOTHY C (PT)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:C
Last Name:NOSBISCH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 CARTER ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621
Mailing Address - Country:US
Mailing Address - Phone:585-339-4793
Mailing Address - Fax:585-336-4845
Practice Address - Street 1:692 MILLERSPORT HWY
Practice Address - Street 2:MILLERSPORT PHYSICAL THERAPY
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226
Practice Address - Country:US
Practice Address - Phone:716-839-9529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012113225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY050209000093OtherFIDELIS CARE #
NY9390427OtherIHA #
NY00011283007OtherUNIVERA #
NY000611346004OtherHEALTH NOW BCBS #
NY159885FTOtherPREFERRED CARE #
NY159885FTOtherPREFERRED CARE #
S80393Medicare UPIN