Provider Demographics
NPI:1861495210
Name:NOSSEK, SCOTT (PT, MS)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:
Last Name:NOSSEK
Suffix:
Gender:M
Credentials:PT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 W MAIN ST
Mailing Address - Street 2:STE D
Mailing Address - City:PAYSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85541-5345
Mailing Address - Country:US
Mailing Address - Phone:928-474-0429
Mailing Address - Fax:928-474-0199
Practice Address - Street 1:405 W MAIN ST
Practice Address - Street 2:STE D
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541-5345
Practice Address - Country:US
Practice Address - Phone:928-474-0429
Practice Address - Fax:928-474-0199
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1674225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ056350Medicaid
AZ1Z6798OtherHEALTH NET
AZF02383Medicaid
AZ650008704OtherMEDICARE RR
AZDOL OWCPOther189208700
AZAZ0295990OtherBCBS AZ
AZ64-00187OtherUNITED HEALTH PLAN
AZ000227851OtherAZ STATE DES CMDP
AZ056350Medicaid
AZAZ0295990OtherBCBS AZ