Provider Demographics
NPI:1790829455
Name:NESBIT, NANCY T (DPT, LAT, CSCS)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:T
Last Name:NESBIT
Suffix:
Gender:F
Credentials:DPT, LAT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 BIRCH STREET
Mailing Address - Street 2:
Mailing Address - City:PARK FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54552-0107
Mailing Address - Country:US
Mailing Address - Phone:715-762-1515
Mailing Address - Fax:715-762-1599
Practice Address - Street 1:500 BIRCH ST
Practice Address - Street 2:
Practice Address - City:PARK FALLS
Practice Address - State:WI
Practice Address - Zip Code:54552-1415
Practice Address - Country:US
Practice Address - Phone:715-762-1515
Practice Address - Fax:715-762-1599
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3939225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI3939OtherWI STATE LICENSE FOR PT
WI37-039OtherWI LICENSE- ATH.TRAINER
WI40174000Medicaid
WIP00454726Medicare PIN
WI000180103Medicare PIN
WI40174000Medicaid