Provider Demographics
NPI:1073366233
Name:NOBLES, MICHAEL (PT , DPT)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:NOBLES
Suffix:
Gender:M
Credentials:PT , DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 FAITHFUL WAY
Mailing Address - Street 2:
Mailing Address - City:SAN JACINTO
Mailing Address - State:CA
Mailing Address - Zip Code:92583-4426
Mailing Address - Country:US
Mailing Address - Phone:951-587-1564
Mailing Address - Fax:
Practice Address - Street 1:12395 EL CAMINO REAL STE 111
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-3083
Practice Address - Country:US
Practice Address - Phone:858-488-3597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA305880225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist