Provider Demographics
NPI:1629143508
Name:NOSEK, ROBERT MICHAEL (DPT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:MICHAEL
Last Name:NOSEK
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 OLD STAGE CT
Mailing Address - Street 2:
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-4706
Mailing Address - Country:US
Mailing Address - Phone:716-984-4726
Mailing Address - Fax:
Practice Address - Street 1:577 E ELDER ST
Practice Address - Street 2:SUITE I
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-3079
Practice Address - Country:US
Practice Address - Phone:760-723-2687
Practice Address - Fax:760-723-2689
Is Sole Proprietor?:No
Enumeration Date:2006-11-23
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5303225100000X
VA2305206761225100000X
CA412992251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB228814Medicare PIN
CACA143439Medicare PIN