Basic Information
| Provider Information | |||||||||
| NPI: | 1710931944 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NOONAN PHYSICAL THERAPY, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4968 MOUNTAIN RD | ||||||||
| Address2: | PO BOX 3421 | ||||||||
| City: | STOWE | ||||||||
| State: | VT | ||||||||
| PostalCode: | 056724885 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8022535694 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4968 MOUNTAIN RD | ||||||||
| Address2: | |||||||||
| City: | STOWE | ||||||||
| State: | VT | ||||||||
| PostalCode: | 056724885 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8022535694 | ||||||||
| FaxNumber: | 8022535697 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | NOONAN | ||||||||
| AuthorizedOfficialFirstName: | HEIDI | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8022535694 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 0VN3447 | 05 | VT | MEDICAID |