Provider Demographics
NPI:1265417109
Name:NOLTE, MARK WINSTON (PT)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:WINSTON
Last Name:NOLTE
Suffix:
Gender:M
Credentials:PT
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Mailing Address - Street 1:200 NEWPORT CENTER DR
Mailing Address - Street 2:STE 213
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7501
Mailing Address - Country:US
Mailing Address - Phone:949-644-1322
Mailing Address - Fax:949-644-0316
Practice Address - Street 1:2101 E 4TH ST
Practice Address - Street 2:STE 170
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3814
Practice Address - Country:US
Practice Address - Phone:714-558-3977
Practice Address - Fax:714-558-0308
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2012-10-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAPT20582225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT20582AMedicare PIN
CAWPT20582BMedicare PIN