Provider Demographics
NPI:1093779001
Name:ROBERTS, DENISHA LOUISE-NOAKER (PT)
Entity Type:Individual
Prefix:
First Name:DENISHA
Middle Name:LOUISE-NOAKER
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DENISHA
Other - Middle Name:L
Other - Last Name:NOAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:625 COMMUNITY WAY
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-2301
Mailing Address - Country:US
Mailing Address - Phone:717-393-0425
Mailing Address - Fax:717-392-7107
Practice Address - Street 1:625 COMMUNITY WAY
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-2301
Practice Address - Country:US
Practice Address - Phone:717-393-0425
Practice Address - Fax:717-392-7107
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT008268-L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017622110001Medicaid