Provider Demographics
NPI:1184094815
Name:NEBELSICK, JOSHUA WILLIAM (DPT)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:WILLIAM
Last Name:NEBELSICK
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 1:2908 5TH ST
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-7317
Mailing Address - Country:US
Mailing Address - Phone:605-755-1100
Mailing Address - Fax:605-755-1116
Practice Address - Street 1:2908 5TH ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-7317
Practice Address - Country:US
Practice Address - Phone:605-755-1100
Practice Address - Fax:605-755-1116
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1511225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist