Provider Demographics
NPI:1023210168
Name:NOONAN, SARAH JOAN (PT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:JOAN
Last Name:NOONAN
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 1:112010 FABER LN
Mailing Address - Street 2:
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-1434
Mailing Address - Country:US
Mailing Address - Phone:952-361-0647
Mailing Address - Fax:
Practice Address - Street 1:6602 HEMLOCK LN N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-6125
Practice Address - Country:US
Practice Address - Phone:763-425-0352
Practice Address - Fax:763-425-1656
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5858225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist