Provider Demographics
NPI:1821194416
Name:NOSOVA, IRINA (PT)
Entity Type:Individual
Prefix:MRS
First Name:IRINA
Middle Name:
Last Name:NOSOVA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3150 CALIFORNIA ST
Mailing Address - Street 2:SUITE #3
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-2464
Mailing Address - Country:US
Mailing Address - Phone:415-775-2319
Mailing Address - Fax:415-775-0852
Practice Address - Street 1:3150 CALIFORNIA ST
Practice Address - Street 2:SUITE #3
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2464
Practice Address - Country:US
Practice Address - Phone:415-775-2319
Practice Address - Fax:415-775-0852
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT21896225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT218960Medicare PIN